HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPL6 w.FQR APPLICATION TO BE ACCEPTED
Date:�1a`1 �� Permit Number:
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Building Permit Application
Planning and Development Services FEB � 7 r 91$
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie County, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial esI entia
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line(
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PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: /(JO . _-) hS ltd &akir1r — sec-lliDYt U 4,(yul 6o; 0_ ,&
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Property Tax ID #: 41500 �51 0-7al 0CQ o7 Lot No.(00<_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional workto e e orme under this permit— check a apply:
❑HVAC 11 Gas Tank Das Piping _ Shutters Windows/Doors
OElectric E] Plumbing OSprinklers FI Generator Roof
Total Sq. Ft of Construction: 0 __)CK S . Ft. of First Floor: ��jo�
Cost of Construction: $ ��J � UtiIities:12Sewer Septic Building Height: la
OWNER/LESSEE:
CONTRACTOR:
Name ice.
Name: (�
Company: 2DJ5 f'tC
Address: U3 v 4LU J61,
City: " State: N_
Zip Code: _ lq_756 U Fax:
Phone No. —%((a q4 .9ZR
Address:;]-(( f!)JE (;<(C64- i 'S f
City: 5k&rli State:�>� _
Zip Code: Fax: —77P �9-7 —n&3
Phone No. —770
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: e&- •Cbw
State or County icense: CCl� (P6_7 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIO fEfV LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
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
commencing worK or recoraing vour ivotice of commencement.
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_ Signature of Owner essee/Agent Sign Lure of Contrac or/License Holder
STATE OF FLORID , STATE OF FLORIDA,��
COUNTY OFQ,�t{r) COUNTY OF /�
The forgoing instrument Was acknowledged before me
this /�'( day of20 !'
b . by
(Name of perso c nowledging )
(Sign atu a of Notary Public- Soto ti
orida )
Personally Known OR Produce Identification
Type of Identification Produced �I T-,)L-
Commission No. (E96a1SUC )i (Seal)
Revi 1CA RESTIFO
F,24_1,�p
2 nev rnMMIRRION # OG91863
The forgoing instrj�wpnt was acknowledged before me
this c .0day of GY�� 20 by
(Name ofpQrson�cknowledging
(Signature�of Notary Public- State
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. ES101 L R"?gF� 4)RESTIFO
A_'My COMMISSION # GG91863
;A '1e E)&IRES: May 17, 2021
EXPIRES: May 1
, 2021
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VEGETATION
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