HomeMy WebLinkAboutBuilding Permit ApplicatiionALL APPLICA LE IN O MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I 1 Permit Number:
Building Permit Application
Planning and Development Services
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: -•- ^ - --]. ,
Address: gB01 50Q 1A �11W I tk0 f"'kV'� 1� 1 �^�
Legal Description: q 1 '(i(- . Co 09 SeC, R�n w, S L 3j3 P �0 Q f GC.
R,&��,•) mf\k � A �.ND Rid SE�.Y d1 2.20�f.
Property Tax ID #: . 550 - oD - COW ` 00®" 5 Lot No.4:9
Site Plan Name: Block No.
Project Name: :ze1e,k e-si zi� Cz
Setbacks Front Back: Right Side: Left Side:
",J.S°TR C1. J.iq'To,`\..Qo.\NS ELe C� C- l.0 s�1iU of o� A/CC,
Haaitionai worK to nje nertormea unaer tnis permit- ci
I_IHVAC EI Gas Tank ❑Gas Piping
Electric _"!E Plumbing -Sprinklers
Total Sq. Ft of Construc on: I L4 -56 't T
�r r
Cost of Construction: CD �.� Ut
s
au�apply:
�vu_I Shutters Q Windows/Doors
Generator 11 Roof
S Ft. of First Floor:
�� 0It
ilities: _ Sewer L_-Septic Building Height: ?"
Name e— ftOLD1C-
Address: 0(\e_M'% o, -oe:,•ie
City: Stater
Zip Code: 115401 Fax:
Phone No. / ` 2— _370 ^ 71 j7
E-Mail: -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: L,>Q 1_>vac\Q0,A\
Company:Sokl -e�S
Address: /5fol 5W (3 f
irnoi`t-
St
City: 'G�S'- I�1 L� _
Zip Code: 34C
Phone No. 77Z - Al "
E-Mail: C]+�t1Cat�sOis.
Fax:
ZLl4f 2-
2�S
State:-E—L
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State or County License: c
L. i6b
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
U'
SUPPLEMENTAL CONSTRUCTIO!N4 LIEN
LAVI/INFORMATICON,
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: m'cy e % F .
Name:
Address:
_
Address: 0SEL .SL C%rc a
City: V0 . L L%t: State:
City:
State:
Zip: 3L4957— Phone: 2— 9WE 550
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.
Signature of Owner/ Agent/ Lessee Signature of Contractor/License Holder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF S� L,�_Cic COUNTY OF fit. Lwc-% �—
The forgoing instrument w s acknowledged before me
this day of W20 4 by
cknowledging )
(Signature of Notart Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification roduced
Commission No.
Revised 07/15/2014
(SOPIFFANY NOON
MY COMMISSION # EE85
The forgoing instrument was acknowledged before me
this _ day of , 20 14 by
(Name of person acknowledging)
'A a aL4 � &-_
ig-
nature of N ry�PPublic- State of Florida )
Personally Known /\ OR Produced Identification
Type of Identification Produced
o mission No.EEjg33yui7j
SSeRQaryPublicStateof
Tracey R Mascola My Commission EE 1!
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