HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAPPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED te: Permit Number: I� CA- (3 t� 1 �o
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$Lucoe COunty
RECEIVE®
Building Permit Application SEP 2
nning and Development Services 2'
Iding and Code Regulation Division ST. Lucie Count j Pern
)0 Virginia Avenue, Fort Pierce FL 34982 - -
one: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line's R
Add
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Property Tax ID #: " C� &(0
Site Plan Name: J'�1
ProjectUa
Name:.
Setbacks Front Back:
l
RiehfSide:-,41r`P . Left Side:-W-6, i
Lot No%�
Block No.
Haaitionai worKto oe errormea unaerinis permit-cnecK ail apply:
EIHVAC _ Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
❑I Electric Plumbing OSprinkl El Generator 0 Roof
Total Sq. Ft of Construction: _/ v 'd SQ.-Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer Septic J Building Height:
Name C- IbW7 9—Gv C,C� Name: l
AddressA49d Company:
City: I % /,t!.�lirs Y(!� State:.AV Address: / &0 Oa
Zip Codec /1Fax: City: 6t fVA State:
Phone No Zip Code: c33 21 Fax:
E-Mail Phone No.�h1O/'9 1r, w-If0*0
Fill in fee simple Title Hol r on next page if different E-Mail:t /ti ,D �RQ/,Y,c�G�Q�ja1�/(i1 S
from he Owner listed above) State or County Licensq, rAf 45T&86CT
-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNE
Name:
NGINEER: of Applicable
�) o4-
MORTGAGE COMPANY: _ Not Applicable
Address: t
W.1412hln
Name:
Address:
Cit�r:
State:
City: State:
Zip,
Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City:
City:
Zips
Phone:
Zip: Phone:
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 recordine vour Notice of Commencement.
ST/
CO
Co
01-�—
re of Owner/ Lessee/Agent
OF rY OF OR � lrn k4ed?Cb
doing instr men as a knowledge efore me
_ day o 20 by
of person a
iature of Not2ry Public- Stafc(of Florida )
orally Known \�/ OR Produced Identification
of Id e if i
Apr nr, No-ry Public State of Florida
nissi N� rances Donza SeaaII11
y, < My, Commission GG A244sY
'�i�oExpires 0712712021 - -
07/15/2014
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Ahn laok
The forgging ins u as �cknowledge�(�fore me
this _day of �[(,(� 20 /�_ by
(Name of person acknowledging )
(Signature of Notaryl Pub %V- State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
pOW'N Notary Public State of Florida
. 4Franrac nnn,.
my Uommisslon GG 09244o
Expires 07/27/2021
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