HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONt
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:01 C�'��' Permit Number: 11-loy.
RECEIVED
Building Permit Application AUG 3-0 2017
Planning and Development Services PER-MITTING
Building and Code Regulation Division St• Lucie r",:nty F•
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
Address:
I Description:
PC OPLor 15 CMAO, 131130 ;r_0E-. 3-6sa -ias
Property Tax ID #: 1 mot — CO15 019 Q — Lot No.
Site Plan Name: Block No.
Project Name: —C—�fo _ E�Ce
�-^—
Setbacks Front Back: Right Side: Left Side:
❑HVAC LJ Gas Tank HGas Piping
11 Electric 0 Plumbing []Sprinklers
Total Sq. Ft of Construction: Igao
Cost of Construction: $ , Ur ow, OD
LJ Shutters
Generator
S�Ftj. of First Floor:
Utilities: 0Sewer Septic Building Height:
I"W
OWNER%LE°SSEE" a
i k
CONTRACTORS ;, t
Name D.�A
Name.LL(Ln
Address ' (03 Ln;Rr AvdED P-0,40
Company:
city: Stater
Address•390k SE plt=�4 —MT42-FILE
Zip Code: Fax A—Ja 81a
City:SILLRLT- State�L
Phone No.
Zip Code:L3PE • Fax r� —
Phone Noa — �33
E-Mail VV-+
Fill in fee Title Holder on next page (if different
E-Mail: e
simple
State or County License:(
from the Owner listed above)
If value of construction is $z5oo or more, a KLLUKUtU nonce oT %.ommencenlrnL I� i cyuu
SIJPPLEMENTAL�CONSTRUgCTION
LIEWN LAW INFORMATIONw
L v tyt3V 5�,*`s,L :3 F
.
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 lend e r an attorney before
commencing work 4.-recording your Notice of Commencement.
of Owne
STATE OF FLORI
COUNTY OF
nt
STATE OF FLORI
COUNTY OF
cense
The.jr ng instrument was acknowledged before me The forgging instrument was acknowledged before me
this day of Q_tx0llAd-i 20 Q,by thsiday of 20 by
(Name of person acknowledge ) (Name of person acknowledge )
-(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identificati) Produced
Commission No.
Revised 07/15/201
(Seal)
MY COMMISSION # GG127632
EXPIRES July 24, 2021
(Signat re of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identificati n Produced
Commission No. (Seal)
MY COMMISSION # GG127632
EXPIRES July 24, 2021
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