HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INF MUST BE COMk-E-TED FOR APPLICATION.TO,BE;ACCEPTED,
Date: '�� i 1, yl
Perm it Number: I�I �.^U=IA;{
• - RECEIVED SC,
sit
ANNED,
Buildiing.Permit.Application_Lucie co '
Planning and Development' Services' .. , ; - 7- fprmltting Department unty
Building and Code R
'egulation Division B' U, . < ..'.?I �;''I St, Lucie county ' . ., . - � •
2300 Virginia Avenue, Fort Pierce FL 34982- - - -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial - Residential
PERMIT APPLICATION FOR: To Select from-dropboz, click arrow of the end of line `
PROPOSED IMPROVEMENT LOCATION: '
Address: - a315, S,c�w!�o-�a�gl�
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LegalDescription:'�36b'
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Property Tax ID#:- 3�2„+-5D,7� dO7ij'-dCJO �•
Lot No.
Site Plan Name:
"' "' v Block'No: '
Project,Name;
Setbacks Front"
Back: ' " " '`
Right'Side: ' Left Side:
DETAILED DESCRIPTION
OF WORK:
CONSTRUCTION INFORMATION:
Adclitional worK to e e orme un er t Is permit- c ec a app y:
CIHVAC- - - UGasTank- - E]Gas Piping-- ='Shutters Windows/Doors
[]Electric ' Plumbing - Sprinklers Generator , '--t.lRoof- - J Roof pitch
Total Sq. Ft of Construction: - - - 'S Ft. of First Floor: _
,Cost of Construction: $ i 9%63 Litilities:USewer Septic Building Height:
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Address �1 � tc✓bc+�tyZy
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Company: C_E91�Gi!l91�
City. oi(tSt-_6V6tG State. -
Zip Code: 3 $(o Fax: . ,
Phone No.Ri(o—
.Address. _!l_3�`�d
City:.. B1,4,de4i7iV State:-n-,
Zip Code:-1 3Lf Z0$ Fax: '<"
tPhoneNo. gLei f LF$ 76;
E-Mail: �PdtNcrVCrGirPIJrIL., L'aM-'
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above).
E-Mail: K.$t`t • C.aM Ltn% i�l�L C(i �I n •,
State or County License:, G6C
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION'LIEN'LAVU'INFORMATION
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.
St. Lucie County makes no representation that is granting a permitwill 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 OW ER: Your failure fo Record a Notice of Commencement mayresult in your paying twice for
improvements to y ur Ioperty. A Notice of Commencement must be recorded and posted on the jobsite
bef a the first ins a n. If you intend to obtain financing, consult with en er or an attorney.before
co encin wo or ordin our Notice of Commence ent.
' � ''" �` � '" � "• '"�``
DESIGNER/ENGINEER: - _'Not Applicable MORTGAGE COMPANY: Not Applicable "
Name: Name:
Address: Address: -
City: State: City: State:
Zip: Phone � , � zip.:--- ' � ; Phone:FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: `Not Applicable
Name: Name: � '
Address Address:
City: _. • - - _--• City:.
Zip: Phone: - Zip: Phone: _
Signat y of Owner/ ess a/Co for as Agent for Owner
Signatur of Contractor 4): icen older
STATE OF FLO IpA
STATE OF FLOf�14A
COUNTY OF I"I Gl{'10.�fi2rei
COUNTY OF 1"I(IIY1QJ--Q-Q,
The for ggo�ing instrument was acknowledged before, me
NoyQrnbeY
The forgoing instrument was acknowledged before me
this�ii"dayof Nove'w\bW r:20�`by-
this ,�'dayof .20A by
k2rhoty,k2a-l�ng
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Name of persgn making state ent
Name of persgn making state ent -
Personally Known V_ OR Produced Identification
Personally Known _� �L OR Produced Identification
Type of Identification
Type of Identification
Produced ,,•;
+Produced ,
,
(Signat re of Notary P
e o