HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COIMPLETEb FOR APPLICATION TO BE ACCEPTED � I
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Date: I�
SCANNED
BY
St. Lucie County
Building Permit Application
Planning and Development Services ,. 'f1 _
Building and Code Regulation Division �,OcQty.ton c�71bn � � �N 1_4 "t�_/�) 1 • �r�
2300 Virginia Avenue, Fort Pierce FL 34982 ✓ ,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I PROPOSED IMPROVEMENT LOCATION:
Address:
Legal
x
Lot No.
Site Plan Name: tA 'Lri/LL' (L-Ae " Block No.
Project Name: alie-
Setbacks Front �Back: Right Side: / 0 ? Left Side: .lid
DETAILED DESCRIPTION OF WORK: III
e-0 cva u O O
n
I CONSTRUCTION INFORMATION: I
❑HVAC ❑ Gas Tank ❑Gas Piping U Shutters ❑ Windows/Doors
Electric c0 Plumbing ❑Sprinklers ❑ Generator ❑ Roof
IS D.TNQs
Total q. Ft of Construction: ��/� S Ft. of First Floor:
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Cost of Construction:$ 35dD.%J7i Utilities: Sewer ❑Septic Building Height: F?
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: PD
Company
Ca .LAV,
City:h'k . pk"i � State:..
Zip Code:31 0117 Fax:
Phone No772 -'%G 5-6,0 //
Address:
Cit% f�a[.r'c,e
Zip Code;_��
Phone No. 7
Stat'e/::-
Fax:7�,2 -z161 - o7/67'
-0 i 7S9
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 5'/,6,fJ5 -I'd
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State or County License:
SLR
Ire 6 8 5"1
$ It
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNInNG NEE
Name: wI
_
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: (G
Address:
City: -0YI r&1f
Zip: 5 / a // Phone: h°7 51`�7
State: -
!— 5�3 9
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City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_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 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.
Inconsideration 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
��5 (^G Z-wT
Sign V
ure of Owner/ Agent/ Lessee
STATE OF FLORIDA%`
COUNTY OF �'A
The forgoing instru ent was acknowledged b fore me
this 12Sday of 20 by
t' onally_Kn@V1h OR Produced Identification
gyr 'N Notary Pudic State of Florida
Commission No. Trade L LA6aal)
+�, My Commission EE 159114
'ro, i Expires 01252016
Revised 07/15/2014
Signatu of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this %? day of 20�f by
PCrsonally Knoyln OR Produced Identification
Commission
L Lamb
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DATE
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COMPLETE
INITIALS
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