HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMP'_s.SD FOR APPLICATION TO BE ACCEPTED T(_Cxx II
Date: - 7 ' / 5J Permit Number: 60I.&JUQr C J
SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie Countv
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 'Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
LP.ROPOSEp;,IM'PIRp�OVEMENT LOCATION.'=
Address: 4 7/ i f A/f% # JiZ I
Legal Description: aQ-1= eC--CS L/ V-Ial E ten/r zZ/ (02 3073 - /3a&
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEQ.DESCRIPTION O,F WORK:
7. r.1...b m A. ..-?_?v •Tt In• ra•%arrFc'k.�s 'N, (' .3 { _
t�
��LrPL ¢GL Cl /�7�Q
an /n/o/tr,/
tl /o& a ` d �ciLaiti/p, 401774
/7��t 0/ EQ��i Y7
JJt1 i �/ O
CONSTRUCTION INFORMATION
mto ` u
F rst'
rtiona wor orme under
❑HVP Gas Tank
this permitcheck
❑Gas Piping
all apply:
_ Shutters
❑ Windows/Doors
❑Electric ❑ Plumbing
❑Sprinklers
❑ Generator
❑ Roof
Total Sq. Ft of Construction:
Sq Ft. of First Floor:
Cost of Construction: $ 22Oa as
Utilities: I❑Sewer ❑Septic
Building Height: /
;OWNER/=�:
'.Pra-f�
� } �`' •
CONTRACTOR•
Name
/¢S/SOG ,
Name: 6)MlS l47?nI -S'
Address: �/9y% .N.4/. `S
U putt
hEompany: %/�S Cam»�tCG%/6�
City: �T �i � ZP�7v l�/
Zip Code: cf -V g 7 g SF x.
Phone No. 77a
State:
Address: /0 f'F29- 1&1eSC- 6It-?Ie
City: (/fib F27,kci,1- State: Y�l
Zip Code: 3h 9 &0 Fax:
Phone No. 7 702 q 7 3 cl r2- /
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: L'/}sLIS7fYJy1 KP�/�nSrn y�Crioy/ _gM/hC . (o>r]
State or County License: 03C 05 f 00 7
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ,^
/41� Ode / g 6a� Q �111\
SUPPLE MENTAL'CONSTRUCTI
IEN LAW INFORMATION: :'
a f
DESIGNER/ENGINEER: _
Name: 4W.A -r
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address: Roo Am Sr
Address:
City: !/ram 3611-
Zip: 3L9 Phone: 772-
State: PG
Z-2—& -7a iz
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: p(
Name:
Not Applicable
BONDING COMPANY:
Name:
Y Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy 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 yoliintend to obtain financing, consult with lender or qh attorney before
Signature of
Holder
STATE OF FLORIDA STATE OF FLORIDA _
COUNTY OF COUNTYOF
The f oing instr ent wa acknowledged flefore me
this day of 1 20 _ by
Personally Known +
Type of Identification P �yt,
Commission No. f
Revised 07/15/2014
DAWN MILONE
Cl)Expires Mar 22, 201
C Mission # EE 877571
Bonded Through National Notary Ass
The for oing instru ent was acknowledged before me
this T day of a / 20_1g�by
1 4 r )
(Signature of Notary Public -
Personally Known _
Type of Identification
Commission No.
ng)
of Florida
Corn �i§�@P# Ea17
877571
Bonded Through National Notary Assn.
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