HomeMy WebLinkAboutBUILDING PERTMIT APPLICTIONALL APPLICABLE INFO MUST BE COMP''' D FOR APPLICATION TO BE ACCEPTED
Date: a�R. l Permit Number: 15da-d01�
er
SCANNED
Building Permit Application BY
St. Lucie County
Planning and Development Services
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 ��e C
._
Address: 7a fl e
Legal Description:
Property Tax ID #: 336 Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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AlWEIIN
Additional work to e e orme under tispermit—c ec a apply:
11HVAC LJ Gas Tank ❑Gas Piping I Shutters a Windows/Doors
_
Electric 1:1 Plumbing OSprinkiers Generator Roof
Total Sq. Ft of Construction: d✓ 6 S . Ft. of First Floor: 440
Cost of Construction: $ s'c�— utilitiesSewer Septic Building Height:
Name d G<
.. _.,
Name: Efr
Company: �7 G F/P� ! C
'Address: UL
,City: o h Jn �� L. State: jEk�
Address:167r ' , c' .(2
City: ADVPIAn .rt-/A State:�L
Zip Code: 34z/ M Fax:
Phone No. - 7 " 6� �—
Zip Code: 3-1 Fax:
E-Mail: %"C�o��Sri �f/%�1%��' +i�
Phone No. 4 i
Fill in fee simple Title Holder on next page (if different.
E-Mail: 01, P/ e14 m yQ ?Jn
State or County License: ,P�_L Oob
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
iI
UtSIUMKIMMUINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State: .
Zip: Phone: Zip: Phone:
FEE SIMPLE -TITLE-HOLDER: — Not Applicable BONDING COMPANY: - Not Applicable- -
Name: Name:
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 vour Notice of Commencement.
Lessee
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6t. \ V C COUNTY OF i • 1-uz i
The forgoing instrume t was acknowledged before me The forgoing instrumen was acknowledged before me
this day of Yr20 Eby this 20J5 by
c e tar 1C e r`v o Y\ S c o �1-ft \t e V\ ti b
(Name of person acknowle ging) (Name of person acknowledge g )
(Signature of Notary Public- State of Florida ) I Signature of Notary`Public- State of Florida )
GIVEN t FI°nda - A GIVENS
Personally Known rroduced IE# i �tfo�4 c� "Personally Known Tpduced Id ITIca�ivn of R° ida
Type of IdentificatInw d Y�°° s oeG Type of Identification Proms °e< � t o s oe�e�0
:MY Gom istoossmCommission NO. ,. G �°al)°%,96°aa1N Commission No. � :. - a°� �0l�eala Nallonal Notary
Revised 07/15/2014
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