HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLI ABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c7 Permit Number: P
LGKOLS JUL ?
Building Permit Application PEF-;I fITTINPG
Planning and Development Services Si. Lucie County, 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
OR OPOSED'IMPRO,VEME_NT LOCATION
Address: 6 I S-6 06 0--A rJUS Ait i i�(A sA• L_uG(-P , pzl [_ h/6
Legal Description:
Property Tax ID #: ; -1. r q _ 5 �>o ®io p �' �d �%� S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESC=RIPTIO.N O'F'WORK': r
CONSTRUCTION :INFb.R-MATION:
Additionalwork to be nertormed un er this p it - check a apply:
11HVAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
d
Cost of Construction: $ 9CV
S Ft. of First Floor: _
Utilities: Sewer1:1 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR;:
Name A4te'VS ,SO *0
Name: CtgxD ovL - cprcOs/SLug=
Address: Ag(a iXA
Company:
City: State: ''�
Zip Code: 7240103 Fax:
Phone No.
Address: g52�6 SA) 6x42G- V-,4
City: State: -et.
Zip Code: ZLfAct ( Fax:-
Phone No. `77�- Q&V— IQOD
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E - M a i Q2,P_ i -A 06(P & mof' dncr, A, `^
State or County License: d-95,6 ea
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
l
SUPP•L'.E,MENTAL CONSTRUCTION 'L'IEN�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: _ of 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.
re of-O'Wner/Lessee/Contractor as Agent for Owner
ctor/License
STATE OF FLORIDA " 7�_ STATE OF FLORID��C
COUNTY OF %NAZ /1v COUNTY OF (/1/y
The forgoing instrum nt Vas acknowledged before me The forgoing instru ent was acknowledged before me
thi day of 20 /7-by thisv?7 day of 20 % by
D—&--CnL� V&h n L'I e��ab C;- k--)
(Name of person acknowledging) (Name of per -oh acknowledging) _
of Notary Public- State of Florida )
of Notary Public- State of Florida )
ersonally Known ✓ OR Produced Identification a onally Known _ OR Produced Identification
Type of Identification Produced ype of Identification Produced
Commission No. (Seal) Commission No o, 070 (Seal)
CONNED (�da -' NER' a
Sta Spate o
Pu4ttc Q96010 �pNE 6010
Revised 07/15/20 , '�y PUe,y., NotatY * GG 10 20Z0 GG03 2p20
•� P��� N tatY e a t a 10, s
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