HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 °
'd 60,0,` RECEIVED.,
_. - _._
Building Permit Application AUG 2 9 2017
Planning and Development Services TING
PERMIT
Building and Code Regulation Division , FL
St. Lucie auntymy,
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
PROP05E0}IIVIPROIEMEIVT LOCATION' y
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Address: �2(002 Sfllkf FOB' �~ , FU 4GS�
Legal Description:
Property Tax ID #: \3d` ` W `t `020c�" ou 0' !O
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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V� n WIC s c ll� _DC Use-D -1-MRPC_rG, -4M)D14 ¢ L
CONSTRUCTIJN�I�CORNIATIaN.....°
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Additional work to e er orme rider er this permit — check a apply:
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11HVAC L_J Gas Tank DGas Piping _ Shutters a Windows/Doors
11 Electric 0 Plumbing Sprinklers ❑ Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $� ;ilities:� Sewer Septic Building Height:
�iIUNER jI�ESSE {�
Name \�—� O Name: w. o�c� S t
sfiN i q V�0&6) t") Company:
Address
1�-Ocry tate:TL Address: JrOW
City:
',_ ( ileer.Gh State-.j�.
Zip Code: Fax: City: ev
Phone No. aSL}' 7��' � lli Zip Code: 33 `4F� Fax: J-4 t; — J°'11"1
E-Mail: N1d&�i'1 i% � ���I C0`'\ — Phone No. 6 b'
F111 in fee simple Title Holder on next page ( if different E-Mail: $ee,-et jet 95 If-S. O x � Lot, —
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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
corrmTsuing work or recording your Notice of Commencement.
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Signature of Owner/Lessee/ r as Agent for Owner Signa Ture of Con actor/License Holder
STATE OF FLORIQA STATE OF FLORIDAI
COUNTY OF �j ac) [. an-i _ COUNTY OF /t✓2�Wc�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_ day of 20 LT --by this 0'61 day of sc.I/I 20 17 by
1
(Name of person acknowledging) (Name of person acknowledging )
44, u),Ae, a4,&
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known )_ OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014 I (407?— ?--'=3
Personally Known X OR Produced Identification
Type of Identification Produced
ORITA KAY WE m sion No. fir' i*S57
MY COMMISSION #F 185772
RITA KAY WEB
M, J•_ MY 72
o;
�i EXPIRES March 9, 21 19
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