HomeMy WebLinkAboutBUILDING PERMIT APPLICATION`All APPLICABLE INFO( MUST BE
Date: 3 -P L8
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SLAW ED Permit Number: I S7V 3- 0311!\ y
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Building Permit Application
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Planning and Development Services Permitting uCountye
St. Lucie Country
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578 Commercial Residential _
PERMIT APPLICATION FOR: _ J
Address: 3 31� A0..�'�'.C-Y1
Legal Description:.2—pp1 35 rV
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Property Tax ID #: C�_�4 c21
Site Plan Name:
Project Name: L Y1-Q S 1S
Setbacks Front Back:
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Right Side: Left Side:
'F1a�k?r�t - ynS-�a.1ll shn�-}1r-�.•�. tit.�ct�.�.c:
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank ;' Gas. Piping _Shutters.- Windows/Doors '
_ Electric _Plumbing _ Sprinklers _ Generator _Y Roof Pitch
Total Sq. Ft of Construction:. Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer _ Septic Building,Height: AG
0 NsEaJ ESSE<E:
CONTRACTUR:
Nam
iS
Name:
�Address:.3�3 A`�1' •„�0�."��"i-'� S II
Company.• Y1�j
S �S
City: �L�..,."'Q i•e d� State
Zip Code: Fax:-3c
Phone No. �' �.�8`7;_O- - 8039
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) I
Address:.37
City: State: `C,(,
Zip Code: .Fax:
Phone Noo2+'%-"O�'3�
E-Mail `RQD Y-I S- �-c
State or County License CCC N3 O 211AtS
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
'PPL .
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DESIGNER/ENGINEER:
Name:
Address:
_ Not Applicable
"MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
I
,FEE. SIMPLE TITLE HOLDER:
Name:' ' .. "
Address:
City:
Zip: Phone:
_ Not Applicable
I
I
I
" I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AOIDVIT: Application is hereby made to'obtain a permit to ."do the work and installation as indicated.
I certify that no work or installation has commenced prior to Ithe 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, scIreen'rooms and accessory uses to an'othernon=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 our Notice of Commencement.
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Signatur Owner/ Lessee/Contrac or Owneir,.
Contractor/Licens o
=TE
S TE OF FL RIID
FLORID
COUNTY OF "
'. '
COUNTY OF
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The f rgoing ins ment was acknowledgedbefore me
thisE day of Q 20 by I
The forgoing instrument was acknowledged before me
this � day of _���} 20A% by
I
.
(Name of person acknowledging) I
(Name of person acknowledging)
I
State of Florida)
(Signature of Nota;7OR
(Signature of Notary PI li -State of Florida )
Personally Known Produced Identificati
Personally Known fNL OR Produced Identification
Type of Identification ;s—ate
Type of Identification
Produced OJGc�°a ; •
Produced
Commission No.5�� �°e
Commission No."
REVIEWS
FRONT.
SUPERVISOR
PLANS
VEGETATION �',
TL
MANGROVE
COUNTER %!
REVIEW
REVI
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
3
COMPLETED
dolts
ev.7/2014