HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
All APP LIICABLE INFO MUST BE COMPLE i cv FOR APPLICATION TO BE ACCEPTED
Date: !'(-C`I -�$' Permit Number: ((- �J ?3
SCANNED
-� BY
Building Permit Application St Lucie County
PlanninIg and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
NAME LC+1G TIC?
f
Address m�� o s 1a,CA-C�n \CkA)/F 4 F—l� C Q
Legal Description: V-C VJ ,('
-a
Property Tax ID #: 13 (_i j0.5 JD c j D "® C> o 16 Lot No. .
Site Plan Name: Block No. L01
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIILD # E=SCRIPi'I`ON OI= WORK:
LA 1
&t�CQ � L `
Nei�Nitiona
wor toper orme un er t is permit — c ec a that app Y.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.' Ft of Construction: 1,00o Sq. Ft. of First Floor:
Cost of Construction: $ aid (9 O Utilities: —Sewer _Septic Building Height:
NO
CONI"RAC7"C}R:
Name
Name ci, P -\nrn a-'fq
Name: i
Company: "
Address: ,� a (� Qr f-\-- V-C- S -LU •
I
City: \jz V'O State: !�L
- _
Address:
City: Stater
Zip Code: 619 Fax:
I
Phone No. n -
Zip Code: Fax:
E-Mail: d I� I. C`
Phone No
Fill in fee simple Title older on next pa (if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City.
State:
City:
State:I
Zip: Phone
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicaile
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: 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 the issuance of a Permit.' i
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
commencingrwork or recording your Notice of Commencement.
caner/ Lessee/Contractor s Agent for O ner
Signature of Contractor/License Holder
STATE OF FLORIDA `
STATE OF FLORIDA
COUNTY OF q � LAkc R
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this —�C1 day of 202 by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification `r
Personally Known OR Produced Identification
Type of Ide�atifi`cation
Type of Identification
Prod
Produced
(Signature of Not
,SStte GHN
o= ate of londa otary Public
(Signature of Notary Public -State of Florida )
L'
'• P; Commission #GG 270079
%�
Commission No..
��°c' M Comm(Q04 Expires
Commission No. (Seal)
Oeteber 22. 2822
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
RECEIVED
DATE
COMPLETED
Rev. 8/2/17