HomeMy WebLinkAboutBuilding Permit Application A"HrrLIUROLC 111mtU MUs t 15b Gumpirol FOR APPUCA71ON TO BE ACCEPTED
Date: Permit Numb.
Building, Permit Applicattion -
FEB 2
Planning cnd Development Services . P E R M I TTi NG
Building and Code Regulation Division. St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce F04982 /
772 4 2-1553 Fax: 772 462-157s Commercial Residential
Phone ( ) 6 ( ) _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Ism
Address:
Legal Description:' G`rc-M jAk L&_Q G w
Property Tax f D#: 2 70 t � . (��d�� 0 ov Lot No.
Site Plan Name: AQ� AV Block No'.
Project Name:' "I VNCe
Setbacks. Front ` . Back: Right Side: Left Side:
e--
Additional work to be e rme '- under this permit—check all that apply:
OHVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
aElectric ❑_Plumbing 0Sprinklers Generator Roof
Total Sq.Ft of Construction: �C S .Ft.of First Floor:
Cost of Construction:$ `�`� Utilities: Sewer Septic : Building height:
Name CCJf 0.S Q" t�� Name:
°Address: 2 Company: G
C' —(7r t rcG - State• (. " Address AL4 1 sw kii" ST
City: t K State:
.Zip Code: 4q Fax: Gv�Q2 Vnr) ail _ 'f
Phone'No. ��Z' ' " C Zip Code: `°�506 Fax: Q 5'"T —7�" �
E-Mail: Phone No. GU_ 2.2.6- 16717
Fill in fee simple Tide Holder on next page(if different E-Mail: a. �rn A 0\WAS d la , Cow`
from the Owner listed above) State or County License: C co? 2--797
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. :-
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: r'
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: many:
Zip: Phone: Zip: Phone:
1 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 cenflict 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 Notice of Commencement must be recorded and posted on the job-site
before the frrst-inspectio you intend to.obtain financing,consult w' . ender or an attorney before
commencn work ox4%:rc_ord1nR vour Notice of Commencement
Signature of OwnePDA
� t/Lessee ature of ntracto tense Holder
STATE OF FLO/R 1)I'al� ,(� STATE OF FLORI A
COUNTY OF (,C COUNTY OF_ ✓DlO
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of 20 b}' this day of :20J by .
(A, V J��l�n Pi"LAM
(Name of person acknowledging) (Name of.person acknowledging)
9(A�As�p"'c'
(Signature of Not#y Public-State of Flo ida) (Signature of N ary Public-State of Flo Ada)
,►AY ft biA PAGE
Personally Known O 1•0 WSW Personally Known OR Produced tification
Type of Identification-ProduL` * .Mt! Type of Identification Produced °`:"':�c SAGE
Boded firuBudgetNafarySenkp
Commission No: (Seal) Commission No. ) edThm S:MNoyS1
Bonded ntra Budget NatarySen
Revised 07/15/2014 -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW : REVIEW
DATE
COMPLETE 1�
INITIALS