HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a • �• l� . Permit Number: 1 7 l "-,
Building Permit Application DEC 12 2017
Planning and Development Services
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 Rr v*r-
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Address: -�l S carl�� /1IC �IAcC
Legal Description: -lf�k l�' 1 i�Ll� �57 7�5 L o t G 6 • SDI h t 17,76 - 9d8
Property Tax ID #: 3 �447 ND'7 Out D- QW - S Lot No.�_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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AdditionalworKtOpeperrormed
under is permit -check all
th,3t
apply:
Q
C,]HVAC
Gas Tank
❑Gas
Piping
_
Shutters
Windows/Doors
Electric
Plumbing
Sprinklers
Generator
�
Roof
%a
Roof pitch
Total Sq. Ft of Construction: '76 • 5
Cost of Construction: $
S Ft. of First Floor:
Utilities: O Sewer E]Septic
Building Height:
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Name Agul,
Name: -RCP10 S,
Address: 4�S/627Z� G� %�C�
Company:(��r�i��
City: F6�°ur fli-&Wc State: )�I_
Address: 5C S- /0JC,0E'>�il C NiZ�L�
Zip Code: 3 VqYl Fax: —'
City: dtIr Sr Luc3� State:�L
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Phone No. -7-7a - q?9 - 05U
Zip Code: �5Yg5_2 Fax: r77a- 33s-RSs�4
E-Mail: �Yi4 tD�'1 �/-�Z1,Soy `/. 1U,a1-
Phone No. `17a- 335- q'SSO
Fill in fee simple Title Holder on next page (if different
E-Mail: LC-Mqy ��IiV1�L/2r�fi1G
from the Owner listed above)
State or County License: &-beh �2--5/J
If value of construction is 1525ou or more, a KtwKuty PAotIee U1 W.UJJJJJJWJJL.C111C11. M
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 recording vour Notice of Commencement.
_ Signature of Owner/ Les ee/Agent Signature of Contracto /Lic a Ho
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF JTZ_UC 6 I COUNTY OF ,57- GGICT,6�-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L)2&ay of A;i�V1:7Y1&z . 20 %by this �jday of /Ul/U&WIjUI 20 n by
�ttt se %mm19e1
(Name kf person ackno ledgin (Name of person acknowledging)
(Signature ot Notary Pub ic- Sta a of Florida) (Signature of Notaryu lic- Stgfe of Florida )
Personally Known OR Produced Identification I Personally Known OR Produced Identification
Type of Identification Produced7)1— bl _! e u Type of Identification Produced
DENISE LEMAY
(g@ OMMISSION # GG 077376
EXPIRES: March 23, 2021
Commission No.
Revised 07/15/2014
* g�MMlssloN#GGan37s Commission No.6'G0913M
EXPIRES: March 23, 2021
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