HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE.INFO MLAST BE CClMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:
k_� Permit Number
- — _ e���P(na,�/
JUG' 3 0 2015
_
Buildirire
-M, Application
'Works
Planning and Development Services
Public
St. Lucie county, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (172) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from-dropbox, click arrow at the end. of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description :)D %r_s c�C� L .� � �D
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Property Tax ID #:�`�l�a - � - O �00 -'a
\.
Lot
Site Plan Name:
Block No.
Project Name:
e
Setbacks Front _ Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional rktobenertormed un er t is permit - check all
VAC Gas Tank Gal' Piping
that apply:
Shutters.
_
_
-
_
Windows/Doors
_
Electric Plumbing Sprinklers Generator
0 Roof
Total Sq., Ft of ConstructionI
: S ..Ft. of First Floor:
Cost of Construction: $ A E) QY::� I Utilities.
Sewer F] Septic
Building Height-
OWNER/LESSEE:
CONTRACTOR:
Name
Address:z-eNk-L.
Company:
City: SL State:'v.t.
ZipCode:3��`n3 Fax•
Addr ss:
City:. Nvlr, StateY-
Phone No.
Zip Code.-7tK�9k`C) Fax:
E-Mail
Phone No.��a-aa3
Fill in fee simple Title Holder on next page ( if!different
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from the Owner listed above)
State or County License:
VC YO U LunauucLwp is ptauu or more, a KtLUKueu Nonce oT Lommencement is required.. : II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable .I
MORTGAGE COMPANY: _ Not Applicable
Name:
e-
Name:
.Address:
I
Address:
City:
r State: �IL
City: State.
.Zip: Phone:
_ I
Zip: Phone:.
FEE SIMPLE TITLE HOLDER:
Not Applicable I
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
I
Address:
City:
;
City:
Zip: Phone:
Zip: Phone: I
I
'I certify that no work or installation has.commenced prior ti 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, iscreen 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 our Notice of Commencement.
I
s
Signature of Owner/ ssee/Agent I Sig re of Contractor/License Holder
.STATE OF FLORWA, STATE OF FLQQ�l�D
COUNTY OF . . �L�C �2 COUNTY OF��..
ThQ forgoing instruo ent was acknowledged before.me The forgoing instrument was acknowledged before me
this dayof 20\-by: I this_ day of�C 20 by
l
(Name of person acknowledging.) i (Name of person acknowledging) .
(Signature of Notary Public_ State of Florida) (Signature of Notary Public —State of, Florida )
Personally Know __—'ORProduced Identification Personally Known ✓ OR Produced Identification
Type of Identiftpatio�;• r Type of Identification„ , ,
S ELLA M. HUNTER ;�o e�•
• •;�p� p�'•., ELLA M. HUNTER .
Not Public : Commission No. ,° Notary Public
Commission N`. Sta(Sepolo►lda f b)ol Florida
• m sstori # FF s . ommlaslon.# FF .180552
M 180552 9.•• My Comm. Expires Jan 23 2019
Y Comm. Expires F OF I
uUnuou rough National Notary Assn.. --IW Notary Assn.
Revised 07/15/2014
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