HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE 1 FO MLIST BE COMPLETED. FOR APPLICATION TO BE ACCEPTED
'Date: Permit Number: 6 • 1 �
REQEHYED
Building Permit Application
-AUG 1 �, 2017
Planning and Development Services .Public Works
st_. Lucie county, FL
Building and Code Regulation Division .
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax:. (772) 4624578 Commercial Residential
Address:- .3 -33
Legal -Description: Zj--f
Z 7-4,?
FL,*T S 5Ll's 01VI sued
Property Tax ID #: 0 40.f - 0 6,0 G Lot No: Z
Site Plan Name: A/ /cL'IOrS ___ Block No.
Project Name: 7*- X. 'A/ Al 0e__6IIO2—T
Setbacks Front N Back: 0 Right Side: 24 Left Side: 32-, J
76cfw,VS A %T /,pl4'e T>4-r-
CONSTRUCTION INFORMATION:
Additional work to a er orme under E] t—checkis-permit a apply:
11HVAC Ei Gas Tank Gas Piping Shutters Q Windows/Doors-
Electric P lumbing Sprinklers 1 Generator EIRoof Roof pitch
Total Sq.: Ft of Construction:: �M
Cost of Construction: $
S Ft. of First Floor:
Utilities: Sewer ElSeptic
Building. Height:
OWNER/LESSEE: =
CONTRACTOR:
Name � S�! �/ C •
Name: At 6- C anrC`/1� _DD%S
Company: Jst.-�?E'S X Z&604no
Address: Avc. .
.%�2lC�
Address: 3?3_3 S#d/-Q14IC' /art.
City:. u-/,c ' lwr So oy . zs4AIV State: 7/k
Zip Code: Y 9 Fax: ±Y-9
City: F-T .P/ DLC State:,
Phone No. 77Z- 93`1— YZO2—
Zip Code: 5 Y�'j Fax:
E-Mail: (1-A!6 AILICE @ I1ZXI 2,0A).1 NtT
Phone.No.
Fill in fee simple Title .Holder on next page ( if different
E-Mail: A1IAIU A Al C, .0IX Qd"?
from the Owner listed above).
State or County License: Cpc- / Y
If value of construction is $2500. or more, a RECORDED Notice of Commencement is required.
uNaf Not App ica a
MORTGAGE COMPANY: Not Applicable
Name-
Name:
Address
Address:
City Stater
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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 ' r3d to obtain financing, consult with lender or an attorney before
commencinR work_ or wor ' =our tice of Commencement.
as
STATE OF -Ft
COUNTY OF
The g Instr owledgec4efore me The f rgoing Ins r
this L day of 20 4by this T day of
J C- ��1C-p-
ame o erson acknowledging) (Na e o person
RAJ
(Signature of Notary Public- State of Florida) -nature of Not
Personally Known OR Pr ce entificatio / ersonally Known
Type of Identification Produced T f Identificat
Commission No. i� �S HEN P. STEWART-DO gission No.
Notary Public, Slate of F
Revised 07/15/2011 JY+tdy Mm • • zpires Feb. 25, 2020
acknowledged before me
W� 20 L by
State of Florida )
OR Produced Identifi tion
P` °"o : FAe j� Ah
MY COMIVIISSION #FF1
EMBER nrdril er 28
398-0153 FloridallotaryService.c
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