HomeMy WebLinkAboutBuilding Permit Application ALL PPLI/GABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date G Permit Number:
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Building Permit Application G° ® � 0, 7
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Planning and Development Services Luc: Coun�1uEy,
St. Lucia FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 .
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRQPOSED )MPR01/EMENT LflCAIQ#11 x _ .._. 4 ..,. :. . . .
Address: t+ v
Legal Description:Nl`k1l�y ��Gr
Property Tax ID#: Cy Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE7`A1LEb DESCRIPTION O1= UItORK `<
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CONSTR_11CT1(7N INFORM%ATIONy � � y
Additional wor to e e orme under this permit-check all a apply:
11HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: �C:O. C� Utilities:nSewer OSeptic Building Height:
0WIN E�%LESSEE s CONTRACTOR k
Namein Name: //�a,�,,, 2Z
Address: 1—A-1 Ts 6WO Company: lJ�s'�2..1.i maor'k-
CityS�5A ( ¢rc� Stat�1 Address;SgI')L_ 0z
Zip Code:.3LVq51 Fax: City i Qm — State 11
Phone No.'1'12,-2 W6-L d4-1 A Zip Code:NqZ+Sl Fax: ,,
E-Mail:,S"- Phone No'-n'.-' Z.L4.o �LA`14
Fill in fee simple Title Holder on next page(if different E-Mail: cbmC_o'!�r.11 �'
from the Owner listed above) State or County License5l'MLD�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGN" /ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:'-.�FCLQ— 600'6d Name:
Address. l TZ Address:
City: "Q State 1 City: State:
Zip: 'NgS3 Phone:`)-)7L- 7J-e0-`4q`1 LP 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 Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
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Signat Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO IDA STATE OF FLORIDA
COUNTY OF l ®� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this—74 day of YVyy(CA\ , 20 Eby this X day of MCkCCA—\ 20 by
Onc wyc Vim' C�'Z -�
(Nam of person acknowl Bing) (Name of rson acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Produced X--L, L Type of Identification Produced 'EL QL
Commission No.0 rJ�J ommi 'on No.O�-1���
•�,aY P�ea SERGIO AMEN
A���• SERGIO JIME EZ -�" B'
Public Slat of Florida 'r := Notary Public•Stag lw!d
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•• Commisslion N JOG 063 550 My CoRatt.:Eglni JY
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Revised 07/15/2014 ' +� �;:� My Comm.Expini J�p 9.?0 „
REVIEWS FRONT ZONING SUPERVISOR PLANS EGETATION SEA TURTLE MANGROVE
COUNTER RE IEW REVIEW RE W REVIEW REVIEW REVIEW
DATE
COMPLETE Y
INITIALS