HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
. t Application B k P rr
MAR 2 2 201?
Planning and Development Services PER-MIT71NG
Building and Code Regulation Division 5t. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IIL�IPROUEMENT LOCATIaN
Address:— 0 '"PA C P �
Legal Description:
Property Tax ID#: �?�Cal Lt (", Q Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D'ET 'ILE;D 0EC►CR1'PTION 'OF WORKr_z �
c�i �
�t cool 1 H l0 A a � et s ��u�`� ��-� 1�d`>� �� , ally
1
el lea A 5�0 Due
i ' c \ c
CONSTR':UCTIC)N INfORMATT
Additionalwork to be pertormecl un er t is permit-check all that apply:
_HVAC _Gas Tank —Gas Piping ^Shutters _ Windows/Doors
_Electric _Plumbing ^Sprinklers ^Generator ^Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ n Utilities: Sewer _Septic Building Height:
OWNER%LESSf co 4
_..
Name 4.r7, ot, Name: Z
Address: Company: , v
City: State:`� Address: p
Zip Code: L _ Fax: City:W "A Asik--x Q)cry State:___I:�C
-Phone-No. 2) Zip Code: � (I Fax:
T
E-Mail: Phone No. ( Q--,5r4)?_()- n!��l.(
Fill in fee simple Title Holder on next page[If different E-Mail: e'k..$ Cc r66-eG��� • N(�
from the Owner listed abode) State or County License: r Etc I so
If value of.construction•is$2500 or_more,a RECORDED Notice of Commencement is:required.
i
r SU.PPLEiVIEN fAL GONSTRUCTIQ�U LIEN LAW fNFORMaTION�
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: r 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
Jn-accordance-with the-approved•plans,-the Florida-Build ing-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
-corn mencin -work•or,recordin -your-Notice-of'Commencement.
t
fi/11V s
L Signature caner/ essee/C ator as c nt for Owner Signature o Contrac ;r/Li alder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY 6F 1 t COUNTY OF P
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisZ_c day of���pS'�A_ � 20 Eby this 2 t day of ram 20 1 by
(tVame of person ac)inowledging) (Name of person acknowledging)
(Si��re of�Notary P7011
State of Florida) Agnature of Notary Public-State of Florida)
Personally Known _ Produced identification Personally Known OR Produced Identification
Type of Identification Produced Type of Id in^on R
�Qy MA®E LA LUZ 1 1SCO } tM MY COMMISSION#GG I
Commission ; a MY SSION lr GeGi150399 Commissi , mber28,2020
EXPIRES November 28.2020
Revised d 14
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE>4 REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS