HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q SCANNED PermitNumber: s ._..
_ BY
`" _ •. St. Lucie County
' - FEB - 9 2015
Building Permit Application Public Works
Planning and Development Services St. Lucie County, FL
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:
x
Address: _ /9z 44 eer_ R04: S?i LUCt�z 3�P �1S2
Legal Description: V %UGtg7 y 1_ pe- 1 z i 26 7 `0 9 34�4S—SG s
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front�� Back: Right Side: —"41A Left Sider
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to e orme under t—checkispermit a py:
E1HVAC - Gas Tank Gas Piping Utl_ Shutters E Windows/Doors
11 Electric 0 Plumbing Sprinklers ElGenerator E]Roof
Total Sq. Ft of Construction: / j 5 S Ft. of First Floor: N�.4
Cost of Construction: $ /�e400.00 — Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: 2 a+1
Name C /� ¢C/�
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Name�,��7Sii
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Address: /9
T/lfl'LJ %Company:
City: A02�,,— S%.
Zip Code: S Fax:
Phone No.%i 7 Z 23
Stater
Address: 3�rrTo4
City: A04—(
Zip Code:
Phone No.
Sic Z,UCIr_ State: ,GL
Fax: 772 336 S3:LO!
772
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 40e MFt14, e &M
State or County License: 2_d122
it value or construction Is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER:
Name: X. A-_ A UX all
_ Not Applicable
MORTGAGE COMPANY:
Name:
1/Not Applicable
Address:/.�5"r-4 C"Vq-M2?FcPLArr
Address:
City:
Zip: �Q_e_T9 Phone: 7
State: �
—
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
✓Not Applicable
BONDING COMPANY:
Name:
_ of 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
commencing work or recording vour Notice of Commencement. If
STATE OF FLORIDA STATE OF FLORIDA L U � %
COUNTY OF 5, Ly c� COUNTY OF_ d i
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this'cV day of 20Aby I this dayof V-JL b 20jjS by
'� A d_� �
(Name of person acknowledging) (Name of person acknowledging))
(Signature of Notary Pdtllic-State of Flo a"'sake°%1. 1O" (Signature of Notary P061i - �Jil*10 P°
�E b\\c'S SOec � Sm QUbGC' Spa ec
Personally Known roduck Iit)rLtN§* a Personally �(Jia#Ir yc�if' e_tri5f t
Type of Identification P ¢ Q o° . pa ' Type of Ide -fi '11 odyA�if m .t�° °'
p=
Commission No. IRo°cj►)� Commission No,: ..-, (Seal)
Revised 07/15/2014
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