HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONy
kLL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ti Permit Number:
imono BuiiJINJI Peri�tWApplication
Planning and Development Services
Building and Code Regulation Division
2300 Virginiq Avenue, Fort Plerce FL 34982
Phone: (772) 462-1553 Fax: (772)•462-1571 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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P,ROP.OSED IM_P.IZOVEIVIEN"LOATIO[U.'�"
Address: 637 6 en C'oy
Legal Description: nL I U YL Pw L2 —u w IT &-r 3�i�►� A 3y��z N loR /563-%3>P7
Property Tax ID #: `T/ 10 0003 060 3 Lot No. .3
Site Plan Name: 1 Block No.
Project Name• 13C&Cf-1 1
'Setbacks Front Back: Right) ide: Left Side:
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Add
itiona wor to a ar orme under t is permit — c ec a apply:
[1HVAC ElGasTank. ❑Gas Piping Shutters aWindow Doors
Electric 0 Plumbing Sprinklers IlGenerator
Roof Roof pitch
Total Sq. Ft of Construction: S . Ft, of First Floor:
Cost of Construction: $ i7 Utilities:. Sewer ElSeptic Building Height:
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!Name VA/a& UI&LiD
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Company: J� eL,L.c�p G%uDP2
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City: OR'— Sr, Zygll'! State: •CL
Address: _030/ S JN D1AN
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Zip Code: Fax: �---
City: R f?T Pre2C le
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Phone No. ' 2
Zip Code:'�3 y��Z Fax:
E-Mail:
Phone No.! Sz / s-iY 9��8
!Fill in fee simple Title Holder on next page (if different
E-Mail: 00w_4 B .9WvRsa44J1PG1NAeR
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'from the Owner listed above)
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State or County License: �?' C
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II IIf value of construction is $2500 or more, a RECORDED Notice of Commencement's required. II
S.U_PLEM:ENTA:`CO.NSTRUCTION .LLEN`;:LAW,:LNF.ORMATION
DESIGNER/ENGINEE Not Applicable MORTGAGE COMPA Y: Not Applicable
Name: Name:
h±:
Address: Address:
City: I State: City: State:
Zip: Phone: I Zip: Phone:
FEE SIMPLE TITLE HOL Not Applicable BONDING COMPANYA - Not Applicable
Name: 2UIA Name: f-
Address• I Address:
City: I City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation tha6s 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 th t inspection. If you intend to obtain financing, consul it lender or an attorney before
comme ing ork or recording vour Notice of Commencement. A_ _
as Agent
STATE OF FLORIDA
COUNTY OF 5S Cu C !
-The for oing instrum wa acknowledged before me
this 4 day of 20 Eby it
Personally Known _Zt! OR Produced Identification
Type of Identification Produced
,+*� % DEEMM RAE U Y
Commission No. �.f"'°►., ..__.J""A �!L I
E9WJvw 16,2021
Revised 07/15/2014
STATE OF FLORIDA
COUNTYOF STCGlc! e
The for oing instrument was acknowledged before me'
this day of .�G[ w, . 20 ,Sby
Po G e Q 16. 8Ae&•J
(Name of rson ac nowledging j
(Signature of Notary Public- Stat •of Florida )
Personally Known >!!f- OR Produced Identification
Type of Identification Produced
Commission `oN':'4• 9130RAH RAE eal)
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