HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE
CON r " -TED FOR APPLICATION TO BE ACCEPTED
Date: —It!` Zvi/ Permit Number:
SCANNED
- - Building Permit Application BY
Planning and Development Services at. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 r
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED 1, R , JEMENT LOCATION:
Address: n bS N \iwy N-\N i \) `� C. N . I JCL -!5 9m C1
Legal Description: CDsw� U"t beach -Sec, a,C, -'S\-- -7
Property Tax ID #:
Site Plan Name:
--70\- - oXAc310
Project Name: rt V 6-U--
Setbacks Front `� Back: —
Right Side: Left Side:
Lot No. 1
Block Nol
oitionai worKto be pertormeo unaertnis permit- cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ Q- Sd6
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
O.W_, R/,LESSEE:
CONTRA M OR:
Names w c3f�ar:,
•u
Name:
.NVCI Y.4+lfN
Address:. .,,:.\_y{�UY C
Company:
1 u �C �/•
p r. .
City:N, i�L\, so Zs�Gra : State:
Zip Code:-'3'144r1 - ` Fax:
Phone No.
•Address:
City: 'beA�� fig
Zip Code:
Phone No ZT9 -
State:-17-76.
Fax:
E-Mail: Lc- V
Fill in fee simpleViitle Holder on next page ( if different.
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
MY PIP LIEM ENRABFOMTRUICTION hIEN L1W 1NF49MATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
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.
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 recording; your Notice of Commencement.
�W
Signatu46 of ner/ Lessee/Contract as Agent for Owner .
Sign ure of Contractor/License, Holder
STATE OF (�
FLORIDA��
STATE OF'FLORIDA
COUNTY(
COUNTY OF
The forgoing instr9spent was acknowledged before me
The forgoing instrument was acknowledged before me '
f 3 5t R
this day of 204 by
this day of 1<(� , 20 by
(Name of person acknowledging)
(Name of person
nacknowledging)
k K y " `U-C_JLX
(Sin tare of No ary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced 4LA19L_'1 ., /�/ o
Produced
Go57g31 ;, BEVqRLYD MARSHALL
•� a k
Commission No. Notary II1 jState of Florida
Commission No. F(IMERTJ. LOWE
MYCONINSSION a FF919553
- y�iy� EXPIRES: oaobc20,2019my
Commission p GG 057931
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Bonded through
ationai Notary Assn
REVIEWS
FRONT ZONING
SUPERVISOR PLANS
VEGETATIO
COUNTER REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED,
DATE
COMPLETED
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