HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLt i ED FOR APPLICATION TO BE ACCEPTED
Date: QL S Permit Number: � S&Q:7 d4S 3
' 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 Residential
PERMIT APPLICATION FOR:
Address:
,rot
01'e✓c e, .rL _
Legal Description: L/Ar '% Wo ,' 3 f at
Property Tax ID #: Ag2-gf-0 I d 07— `% Ooo 3
Site Plan Name:
Project Name:
Setbacks Fr
Left Side: 60 -3
Lot No.—_
Block No._3
DETAILED; DESCRIPTION'OF WORK:
Ft"// xtC"1011 p.�v,a�tiow.
Me,, (,1 hi." -� JV-,-S - Ne-v HV-*r- - AAe. N cAn-/ s 0), &,x%,'/'o ✓ - 3vs a sv c ✓ �ro« �J
Abe-' Ufrww/( — P" J d T"I "
CONSTRUCTION, INFORMATION:
_✓ MVVctC _ Gas Tank _ Gas Piping _ Shutters _✓Windows/Doors
Eleric _/Plurmbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: ID �60 Sq. Ft. of First Floor: ',L COO
Cost of Construction: $ % 00o Utilities: —Sewer ✓Septic Building Height: X
-0WNER/LESSEES', •'�' - a
CONTRACTOR:`.
Name Y..���EL P�pOr%/ iS L
Name e4,/-; %4tr,l✓S✓
Address..
Company,f-A Q:c/4 rC
City: _'✓ti�fJ^ ` Q L State: ,&
Zip.Code;JiI48' Fax: —
Phone No. �41O — 3/0 -C7tlo
-r,'T
Addresti' 'O 0 ' Zc -_A4
City: f%tl0... e tiL ', State:_L�_
Zip Code: sa i ( Fax:
Phone No. 772 - 32/` i07111C
E-Mail: %2C1, e.Sn.. Cor�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: e!fAe�L:7a� /im . Co,1--
State or County License: G'gC 12MC3
11 value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
Addre;
City: _
Zip:,
MENTAL CONS TR ION LIEN LAW INFORMATION:
R/ENGINEER: _ Not Applicable MORTGAGE COMPANY: —! Not Applicable
a." %t Y E"9 %hc•c✓i.. a ��' Name:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Zip:
Phone:
State:
4' Not Applicable
Address:
City: State:
Zip: Phone:
BONDING -COMPANY: of Applicable
Name:
Address:
City:
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
of O er/ Agent/ Less Signature of Contractor/License Holder
STATE OF FLORID/{��� �STATE OF FLORIDA
COUNTY OF�1`1GMco, �IVer COUNTYOF—ZT=bQnGn 1�,��r
The for ring instrument was acknowledged before me The for
gping instrument was acknowledged before me
this j day of lDeQ0 L�rY 20 14 by this day of I�PC?fn der 201¢ by
oablk1 S CucaA I C�O-6-S kaCCA1U.S0
(Name of pers cknowledging) (Name of person acknowledging)
' (Sig ture of Notary Public -State of Florida Q� Lonb�ci,d Si nature of Notary Public -State of Florida )3gnn r U l6o,'il
Personally Known OR Produced Identification Personally Known OR Produced Identification -bL
Type of Identification Produced Type of Identification Produced f= 6AC� llllrtrS Li1c ny-
Commission No. i- Pd I JE CRY LOMBARDINo Commission No. FFUI Uy,��CARYR PUBLIC
I
r�N TAR PUBLIC NOTARY PUBLIC
Q STATE OF FLORIDA STATE OF FLORIDA
Revised 07/15/2014 -'WVe'o Expires 4/21/2017 moist'" Expires 421/2017
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