HomeMy WebLinkAbout1501-0357 BUILDING PERMIT APPLICATION1a
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: - i7
SCANNED
BY
Building Permit Application St Lucie county
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
PROPOSED IMPROVEMENT LOCATIO.N`. ,
Address: 0 1G
(Legal Description:
Property Tax ID # Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION 'INFORMATION:
Additional work to be nerformed under this permit- CheCK a apply:
DHVAC El Gas Tank ❑Gas Piping _ Shutters Windows/Doors
0 Electric 0 Plumbing Sprinklers 0 Generator g Roof
y
Total Sq. Ft of Construction:
Cost of construction: $
S Ft. of First Floor:
Utilities:0Sewer ElSeptic Building Height:
-'OWNER/LESSEE:-
CONTRACTOR:
Name
Name: "I
Company: Gv U• G,tZ C«( oH
Address: '20 2 acO /<eA v A&r-e
Address: e�c� � L_e C �7i.
City: 4 i Ci.111 i _.5 01 State:()}
Zip Code: �, 3 L/ A x:
Phone No.
City: JFt 11e ("G e, State:
Zip Code: 3 9 fT/ Fax:
E-Mail:
Phone No. 77 L- 2-3 7— o-2/ V
Fill in fee simple Title Holder on next page ( if different
E-Mail: _- �> r 2- a f;;A_ Gam"
from the Owner listed above)
State or County License: G 6'L 12 S :?
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: n Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Lvc a-o-'+-w ri�Uv�/t�/I Name:
Address: Address:
City: State: City: State:
Zip:' Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
_ Not Applicable I 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
commencing work or recording your Notice of Commencement.
Signaturfofl*ner/
Holder
STATE OF FLORIDA v STATE OF FLORIDA
COUNTY OF a.�r I-oo ICOUNTYOF c , S
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisPQ day of SCs,__ , 20 14 by I this4;Q day of7t�,n ,.20__14 by
(Name of rso knowledging (Name of pe acl wledging'p"ZIL. L.�: CR��
Si ture of Notary Public- State lorida) (Si re of Notary Public- State o�Ftorida-),
Personally Known OR Pkducpd Identification Personally Known OR Prod IT,
Identification
Type of Identification Produced Type of Identification Produced l
10a� - ap�I---)a.a�01 1IZ3 ` .1a,as'l 0
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS
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