HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLE
Date:
FOR APPLICATION TO BE ACCEPTED oo
Permit Number:
1FIi)
# Y RECEIVED
y sc fflj�'Oermit Application MAI o 2018
Planning and Development Services
Building and Code Regulation Division _ pe mitting Department
2300 Virginia Avenue, Fort Pierce FL 34987� St. Lucie County
Phone: (772) 462-1553 Fax: (772) 4 62 -1578 Commercial Residential
PERMIT APPLICATION FOR: Tb Select from dropbox, click arrow at the end of line
Address: _e
Legal Description:
Property Tax ID Ik
Site Plan Name:
Project Name: _
Setbacks Front,
Aaaitionai worK to oee
F]HVAC FL'
Electric C
Total Sq. Ft of Construc
Cost of Construction: $
yc�_l ice% �� Lot No._
Block No.
e: . i
M
Tormea unaertnispermit— cnecKan apply:
,as Tank Gas Piping In _ Shutters • Q Windows/Doors
3lumbing Sprinklers I Generator E]Roof
n: S F . of First Floor:
Utilities:14 Sewer Septic Building Height:
Y.
Name Y Name:
Address: 11C90a4L Company: J�clek
City; o.Gr' 1 49'x� State-.<Yr _ Address: Z o J/ - v
Zip Code: LTV �?Z� � Fax: City: Z'6414�e State:
Le No. Zip Code: ��� �///�/V Fax:
il: R%G1 t��,(/x�iceo fC4-7P- Phone No. �i/ /`�4`,��f�U Y /plJ
fee simple Title Holder on next page (if different, E-Mail: c�`�°`�`'
the Ownerlistedabove) State or County License:
of constriction is $2500 or.more, a RECORDED Notice of Commencement is required.
UtblUIMM/ UYUP,4M of Hp; ncante
MORTGAGE COMPANY: Not Applicable
Name: if
Name:
Address: I
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: 4
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
i
I certify that no work or installation has
St. Lucie County makes no representation the
which is in conflict with any applicable Home
structure. Please consult with your Home Ow
In consideration of the granting of this requet
in accordance with the approved plans, the FI
ced prior to the issuance of a permit.
;ranting a permit will authorize the permit holder to build the subject structure
iers Association rules, bylaws or and covenants that may restrict or prohibit such
Association and review your deed for any restrictions which may apply.
permit, I do hereby agree that I will, in all respects, perform the work
a Building Codes and St. Lucie County Amendments.
The following building permit applications are e> empt from undergoing a full concurrenry review: room additions,
accessory structures, swimming pools, fences, muIlls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to RCcord 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 intendito obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
1 s
Signature of Owner/ Lessee/Agent Si ture of Contractor/License Holder
STATE OF FLORIDA&STATE OF FLORID
COUNTY OF J�XX COUNTY OF �--
i
The f rg 'ng ins ent was acknowledged afore me
til day of 20 I y
(lame of person ackno ledging )
(Signature of Notary \ Pub ic- tate of FI ida )
Personally Known v OR Produced Identification
Type of Identification Produced
Y % Notary Public State,
Commission No. ;4 ,• Frances Donza
y1� :per My Commission GG
"moo. oQ'I Fvn(b• n7,n�,.......
Revised 07/15/2014
The forg ing ins ent was acknowledged eore me
thi day o 20 by
(Name of person acknowledging)
sluc 9a t
(Signature of otary Public- State of orida )
Personally Known roduced Identification
Type of Identifica n $J,p4uce
c ��e,y runlic State of Florida
• �) Fran
No. Q ces Don49eal)
ommissio GG 092440
os n° Expires 07/27/2021
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