HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date: Permit Number;
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Building Permit Application
Planning and Development Service s
Building and Code Regulation Division
2300 V rgirrtn A venue, fort P1erre FL 34982
Phone: (772) 462-1553 Fa>z; (772) 462.1578 Commercial Residential
PERMIT APPLICATION FOR; To SeIeCt from dropbox, 0ck arrow at the end of line
PROPOSED iMPROVEME T LOCATION:
Address: �U---J 0 ri t 0-CA. CCA E I V6
Legal Description- I o � ' i
Property Tax ID it: - - rt y - Lot No,
Site Plea Name, Block No,
Project Na me: —
etbacks Front B£i-ck: Right Side: Left Side-:
DETAILED DESCRIPTION OF WORK,
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(�ecr., - (c) 5+0L � k (W C'VX k- aA G �X_I ri Je V-C.) C
CONSTRUCTION INFORMATION :
Additionalto per-formedunder t Is perm it - e ep y-
0HVAwork e Gas Tank L]Ga5. Piping _Shutters Ll W i rod ows/D o o rs
[]Electric 1:1 Plumbing 05prinklers � Generator &00f � Door pitch
Total Sq, Ft of Construction: S , Ft, of First Floor:
Co.St of Construction: o Utilities: Sewer E]Septic Bu 1ld1:ng Height:
OWNER/LESSEE. CONTRACTOR:
Name LC,f C Name, � ,� +
Address: mPa��}: 2c%c)k Ld
City: r- r-V .fir C 5tete:EL, Ad d ress; CL&I St 11 M 41ou
Zip Code: .f Fax: city- (T t- WC1 state:E�=
Phone No_ � '" - c
Zip Cade: '3� c?,5g Fax:
E-flail: phone No, `I T , Li- 7L�4,o
Fill in fee Simple Title Holder on next page ( if different E-Mail: ,J ror' ►hq ct�1�a r f i(-,W&Qwa Cie
from the Owner listed above) state or County Licer's
6fvalue of construction Is 25Oil or more, a RECORDED Nati-ce of CommerCern0nt is requireel.
.SUPPLEMENTAL CONSTRUCTION LIEN LAW IN FORMATION:
DESIGNER/ENGINEER: ❑t Applicable MORTGAGE COMPANY: of Applicable
Narne, Name:
Address: Address:
city: State: , City: State:
Zip. Phone Zip; phone;
FEE SIMPLE TITLE MOLDER: -lot Applicable BONDING COMPANY: of Applicable
Larne: Name:
Address; — Address:
City- City: -
Zip: _ Phone: Zip: Phone:
OWNER/ CONTRAC70R A F F I DVIT: AppIi{ation is hereby made to obtain a permit to do thrr worm and -1n5taIIabon as indicated
I certify that no work or installation has commenced prior to the rssuance DI a permit,
St, Lucie Cou ri ty makes no repre.sentadon that Is granting a �ermrtwill authorize the ermit holder to build the 5uhject structure
which is in -conflict With any applicable Home Owners A.Ssotiatian rules, bylaws ar and cove nantn that ma r restrict or prohibit such
structure. Please consul[ with your Home Owners Assiaciatinrn and review your deed fur any restrictions Which may apply.
I n cons id a ration flf t h e gra n t i ng of this req vest ed p erm it, f do h ereby agree th at I wi 11, i n a I I respects, per f o r rn th a wo rk
in accordance with the approved P vn5, the Florida Burring -Codes and St, Lucie Coo nty Amerndmonts_
The following building permit applications are exe m-pt from undergoing a full concurrency review: ro orn additions,
•-irressury structures, Serimming POO1Sr fences, waIIs, signs, screen rooms and acce5sort/ us to -anath�!r rto.n-residential u 5 e
WARNING TO OWNER', Your failure to Record �i Notice of Commencement may -result in your paying twice for
improvements to your property, A Notice of Commencement must be recorded and posted an the jobsite
before the fiat inspection. If you intend to obtain financing, conOt with lender or an attorney before
commencing Wor or recordin .your Notice of Commencement.
5 ignat u re 6vvn a r/ Lens eeIC an t ra ctor as Age,tit for Own e r Signature o o ntra ctnr Liven se H o1 d e r
rr
STATE 6F FLORIDA .STATE OF FLOR
COUNTY OF COUNTY OF LUCk
The for nIng i n stru m ent w-a s acknowledged bef❑re me ThefTday
ing instr ect was acknowledged before me
this day of by thin of f b
N ._
Name of person making statement N a me of pe rs n ma ki ng 5tatem en t
Per5 o n a I I y KnownOR Produ ced I d e n tification — Pe rso na I I y Known 0 R Prod uce d Idea t if ca tion
Type of Identification Tarps of Identification
Produced Produced
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(Signature of Notary Public- State of Florida } ignature of Not c-
rr1 rT'I IS I rl ( ❑. �ul�ea flf Elands N4ta f}f PubliC 5�j 0r Tjorida
oSS rrimission No. { t,�l ���I a
m c ontimiguon Co 308996 My Car ioniss.m GG 2291 QD
or f. [Misirt �J FrzO or �rpire:s �. 0
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUVER REVIEI REVIEW REVIEW REVIEW REVIEW RE EWEW
SATE
RECEIVED
DATE COMPLETED
R-ev_ $/2/17
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