HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE I FO M ST BE COMPLETED FOR APOLICATION TO BE ACCEPTED ()
Date: Permit Number: ! SO I — o l �9
SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Legal Description:9)" C�Z 5A& ®33/� �'17 Zz� `jt 10 d Ae--`
Property Tax ID J-103-502—an73'-0O�<</` Lot No.
Site Plan Name: j - A n Block No.
Project Name: �� gL/ , AF4
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
ytt"�J vu y r-t.o
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CONSTRUCTION INFORMATION:.
Additional work to e e orme . under tis permit - cneck all apply:
I�HVAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction:
Cost of construction: $ / D o"2t-'o -
S Ft. of First Floor: _
Utilities: Sewer Septic
i
Building Height: R 11
OWNER/LESSEE:
CONTRACTOR:
Name U 63 g2 a•
Name:
Address: S',a 55 Z (z 5, ;011�
Company
C4 ,oAd
City: JJ State
Zip Code: Zf Fax:
Phone No.
Address: Pcr/.c..e
City: a • J(
ZipCode:3y!1,/( Fax:
Phone No. 4 — 47181
Stat JAL
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ,5(6A15 30 9iv�ZSO
cc7N . i1/E%
State or County License: 199 P
0 A5 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN
Na
NNGINEER: _ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:/.;)o 6, -4 <, 7�
�
Address:
City: /-3—t L. Q State: Y •
Zip: 3'a,y 3.;� Phone: /-T-S&-9 7/ —3 i 13
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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.
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
commencine work or recordine vour Notice of Commencement.
of Owner/ Agent/ Lessee
STATE OF FLORIDA STATE OF FLORIDA�..I
COUNTY OF J COUNTY OF �71, 6LA
The forPoing instru ent was acknowledged fore me
this �dayof� 20 1 by
Commission
Revised 07/15/2014
OR Produced
N..aq "=an- Stair o, : ,,.
TfaCle L Lamb (Sean
Expires 011252016
The forgoing instrum nt was acknowledged b fore me
this jgday of � 20�y
(Name
of Notary Nblic-Stateof Florida.I
P nally Know OR Produced Identification
e ul luelffification Produced
Commission
Pudic Ste4"Pa
L Lamb
nmission EE 159114
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