HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 11 q
Lela -in yLVirw- JuN -Z & 2017
Building Permit Application
PERMIT T ING
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 0 ,�) /
Legal Description:
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c� — t i
Property Tax ID #: � ` �O6 - 4FS-" 000'1_2 Lot No. 115
Site Plan Name: Block No.
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
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4,r.�i�l,( 26 6A.Q 26 �A- s-V 1 f f�+�w-'zAe
I:JHVAC Li Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $�
OSprinklers
"Shutters
EGenerator
Ft. of First Floo
ISewer 1
QWindows/Doors
19 Roof 2/�:
Building Height:
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ER jLESSE� P ��_
CC}iNTRACTOR
Name
Name:
Address:5313cS' LUD
Company:(rMn/NAt, "OrIN<a
Address:IIOb) c,�G<SoaTH /U:&':�17rY� d1je.
City State: L
City: poor c57-t-1?0,/45 State:_L
Zip Code: 'AUFax:
Phone No. r7b' - b3 3&
Zip Code: 3 Ufs-g_ Fax: M-33V- .SS(f
Phone No. a
E-Mail: :
Fill in fee simple Title Holder on next page ( if different
E-Mail: a • C87j'1
from the Owner listed above)
State or County License: /
If value of construction is $2500 or more, a RECORDED Notice of Commencement is reguirea.
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p� i �� � � 3u € � 2 € 8g '� i • q :.
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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine- work or recordine vour Notice of Commencement--? /
i/� o . X) )/' <"Z.'/S
as Agent for Owner
STATE OF FLORIDA
COUNTYOF ST L-uC16'
The for�g' instrument was acknowledged b fore me
thi `/"8ayof L /�/� 20 by
elwp.Y /3u P�"N
(Name of person acknowledgi
R
(Signature of Notar6 P blic- State of Florida )
FL
Personally Known OR Produced Identification D.L_
Type of Identification Produced 6
Commission I P0110State ftRr
(Simone F 981331
MV Commissto!+_
Revised 07
Signature of Contractor/License
STATE OF FLORIDA
COUNTY OF S"7— L U06-
The for o* instrument was acknowledged before me
thi`Qay of ITUA45- — 20 ZJ by
HOD /YV c
(Name of person acknowledgin
(Signature of NotaryP blic- State of Florida )
Personally Known _K OR Produced Identification
Type of Identification Produced
Commission No. T rypub1k&gIrkFWida
Kimia J Simone
s My CanmissW FF 981331
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SUPERVISOR
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SEA TURTLE
MANGROVE
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DATE
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INITIALS