HomeMy WebLinkAboutBuilding Permit Application ALL ArrLIUMC IMU.Musr BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit.ober: lJ
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Building Pelrmit Application-
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Planning and Development Services FEB, 2.3 417
Building and Code Regulation Division. PER�11171IvG-
2300 Virginia Avenue,Fort Pierce FL34982'.' St. Lucie County,'
Phone:(772)462-1553 Fax:(772)462-1578 Commercial_ Residential-
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end ofaine'
Address:_ of
Legal Description: 6��-,-_ev\ AGr-eS
Property Tax lD# 'I: 36 70l C`0 l -, Lot No.
Site Plan Name: Out Y'i'V),e<.-\C� ,Block No.,
Project Name: �,4
Setbacks . Front "-, Back: Right Side: Left Side
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rtiona wor ME3
Me Munerts p!*echeckallapply. .
OHVAC Gas Tank , Gas Piping _Shutters Q Windows/Doors
a Electric Plumbi OSP
rinklers.. 0-Generator. . ,Roof
Total Sq.Ft of Construction: L 0qq S .Ft.of First Floor:
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Cost of Construction:$_C9�S7 Utilities: _Sewer Septic : Building Height:
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Name rv- A1M _ . -CC C`c� ,. dyl
.A. Name:
Address: .: - 0 . Company::.
City; I (7�1 ��Psc-� State• Addres • ( S W0` S�
.Zip Code: 3 4qq Fax: City: alM State• f
Phone No. r�I - W7 0-• 61753 Zip Code: Fax: .9 5�4-. 7�2 •'
E-Mail: Phone No. CV- 2Z6 G672
Fill in fee simple Tide Holder on next page[if different E-Mail: V�aY i to D av1AS0krl A- , Lo.w\
from;the Owner listed above) State or County License: C C_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNS ENGINEER: _-Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address. Address:
City: State:. City: State,
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable . BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone. Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I-do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements-to your property.A Noticed Commencement must be recorded and posted on the jobsite
before the fi"spection4 you intend to.obtain.financing;consult w' lender or an attorney before
commencin workk cipfe-cordlng your Notice'of Commencement
Signature of Owner t/Lessee ature of ntracto 'cerise Holder
STATE OF FLO DA j� STATE OF FLORI A
COUNTY OF., U row lu ,�J COUNTY OF 1�Dlt�ft f�
The forgoing instrument.was acknowledgeSl.before.me The forgoing instrument was acknowledged before me
this day of . 20 pp_�� by this day of ;25JJ by
(Name of person acknowtedging) (Name of.person acknowledging)
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(Signature of Not#y Public-State of Flo Ida) (Signature of N t ary Public-State of Flo Ada)
Personally known � AGE
0 t�'rou�`ce � Pi( Personally Known. OR Produced tification
Type of Identification".ProduL� €S:fulay:,201g Type of Identification Producedzw
M 224
MfNPAGE
rFlcf��O' BondedThNBu*tNotaryServka F_J{PIRES:May5,201
Commission No'. (Seal) Commission No. '+ �� }WedThrubdoNftS
Revised 07/15/2014
REVIEWS. FRONT ZONING- SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE.,
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE IZ�
COMPLETE
INITIALS �'.