HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:1 1ad� �`` Permit Number:
.- RECEIVED
Building Permit Application DEC o �:9
Planning and Development Services ST. Lucie County, Permitting
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
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Address: —! �. aCSY1lKi DR ` C" S raV AEAC *f FC,
Legal Description: �� ��� m e NQ S 6AJ0S AA'7 bN14. 10-d— 3
A�rID 9(JRThq A DF.sC 91-&V A. -Or Di &W0*-0 S&o& Mi416V atff ii oi
Property Tax ID #: -.Z z� l — 0006 " O 00 % Lot No. S
LIZSite Plan Name: Block No. V
Project Name: t%J 64 Sl 0 r
Setbacks Front Back: �� Right Side:_ Left Side:
DETAIL'°. f DESC
E ED RIPTION OF WORK:
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CONSTRr CTION aN�EORMATIOiN :�
Additionalwork to e performed under this permit —check a apply:
(1HVAC 13 Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 50 Utilities: Sewer ElSeptic Building Height:
OUVNER%LESSEE " ���" ''
CONTRACTOR:
Name H' t
Name: ..
Address: oZ ✓ £
Company:
City: SyR FS I fJ< _ FL. State:
Address:
Zip Code: 735 1 Fax: 305 " f Q-aG59
City: State:
Phone No. SOS — 5 O J — ri�3U
Zip Code: Fax:
E-Mail: (", (2t14N0A ®TM MCI A(2
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW'INFORMATION;:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
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:
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 fir spection. If you intend to obtain financing, consult with lender or an attorney before
commenting work or recording your Notice of Commencement.
of Owner/ Lessee/
s
Signature of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF , �. sc ; 2 , COUNTY OF
The o`r, �oing instrument was acknowledge efore me The forgoing instrument was acknowledged before me
this�yday of (-Z)Q C — 20 by this day of , 20 by
9n Y LM
(Na eo"fCperson acknowledging) (Name of person acknowledging)
( ignat re of Notary Public- Stite of Florida(Signature of Notary Public- State of Florida )
Personally Known OR Pr duced Identification Personally Known OR Produced Identification
Type of Identification Produce L-. Type of Identification Produced
Commission No.
Commission No.
Revised 07/ 15/2014
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