HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO. BE ACCEPTED
Date: Permit Number:
w Building Permit ApplicationAUG i 2�
• PPubublic Works
Planning and Development Services St. 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
PROPOSED iiUI,PRO1lEMENT
Address:
Legal Description:
-2-1
Property Tax ID #: Ny2 -)- �� 0- ��� �' �' I Lot No.
Site Plan Name: ;a ;;"''�` �n �' "! Block No.
Project Name: Hlc�VA
Setbacks Front Back: Right Side: Left Side:
�' sX i / .
CONSTRUCTIQN INFORMATION j� y
'
Acid rtiona I work to be net Tormed under
this permit c ec a
apply:
11HVAC
E GasTank
Gas Piping -
❑a
_Shutters
Windows/Doors
Electric \4_�lumbing'Sprinklers
` ' 11 Generator
Roo;` Roof pitch
Total Sq. Ft of Construction:
S . Ft. of First Floor:
Cost of Construction: $ .2 I Sewer Septic
Building Height:
COfTRACTOR`�„
Name
Name:
Address: �W1��
ry� ....' ,.
9��� V� IC_XCh`
Company: C
\�q"�uo
City: L( ^ \ (1 j
StaB te:-''Ad
I �-,
Z� dress: '�l 1i LLa -1
Zip Code: 2_01JK C� Fax:
- '" .^ -
City: State: I �-
Phone No.
Zip Code: Fax:
E-Mail: a'-��C�C1C�_���Ci
�� }��
Phone No.� (rc5' SZ
Fill in fee simple Title Holder on next page ( if different'
E-Mail:L( �`��Q �� �l �'�C�.
State or County License: ' CYS S2
from the Owner listed above) ; ` ': ':.'"
IIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/"ENGINEER:
Not Applicable-
MORTGAGE COMPANY:
Not Applicable
Name: QXk\Ki
\
Name:
Address: c\
Address:
City: 2
'Stfte.5—kr�!_ 1,
City:
State:
Zip: ? Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not App.liicable:i,,�-of
BONDING COMPANY:
Not'Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
.'Zip:
Phone:
I
1 ' I certify that no work or installation has comm6fic-d-d',-pei'c'i-r-t-o--tHe"issuance of a permit.
St. Lucie County makes no representation that authorize the permit holder to build the subject structure
which is in conflict with any applicable Home OWn'drs Assp6iafidfiYLIIes, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with -your Home OwriersAs'so*cia,-tion-and-:review your deed for any restrictions which may apply.
' b.
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 exe"m--pf..'fr-o'--m-`-u"n-d'6rgoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls,,Slgps, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice ofCommencement may result in your paying twice for
improvements to your property. A Notice. pf.�..Cbrnme6cement must be recorded and posted on the jobsite
comV(before 7rs inspection. If you intend to obtain financing, consult with lender or an attorney before
ng
6;3ng ork or recording your Notice of Commencement.
... .... - 1 .......... -1
i g-aiRn r r/ Lessee/ Lontracior as AgenrTor. uwner
STATE OF FLORID
A
COLINTV OF 3,-q— 'l-A
The forgoing instrument was acknowledged beford me
this day of 20 1-1 by
(Name of person acnovlecl
to
of Notary P4blic- State of Florida ) _ = -- _-=___
Personally Kno,
Type of Identifi
ignature
,STATE OF FLORIDA
;COUNTY OF G�qpO
'The forgoing instrument was acknowledged before me
*this 26"day of 20 1-1 by
(Na ,Mcknowled
(Signbture of Notary Pu�b\ic- State of Florida
;Personally Kn
Type of Ident
MY COMMISSION# FF 9M96
Commission EXPIRES: Ofg�M 2020 :.Commission
13onaminrurioiaryPublic un.d.e",bI
Revised 07/15/2014
Identification
MYCOMMISSION 6
EXPIRES: Octob.311V
Bonded Thru NOWY Public Underwriters
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ZONING
SUPERVISOR:
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
COMPLETE
INITIALS