HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONy
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a6` 15 Permit Number: ISO -a3q O
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Building Permit Application SCANNED
Planning and Development Services BY
Building and Code Regulation Division St. Lucie Countv
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 F �h C 4. III
Address: /V / fig 7U 11I r c_
Legal Description:
Property Tax ID #: J �// Lot No.
Site Plan Name: �D Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
C7N51RUC�t�i11.iFORMATION ; E`k art-
Aaartionalwor topeoeI orme un ert2ispermit—c ec a appy:
11HVAC _
LJ Gas Tank Gas Piping _Shutters ❑ Windows/Doors
11 Electric 0 Plumbing 11 Sprinklers 0 Generator EIRoof
Total Sq. Ft of Construction: a2f /'W" t S Ft. of First Floor:
Cost of Construction: $,� , e D o Utilities: Sewer O Septic
Building Height:
'01ftINE LESSEE `¢ _
`GCIIVTRRCTOR
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Name l G
Name:
Address: � � a�
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Company: W IJI�LPir+'
City: State:
Zip Code: 7i �y�d Fax:
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Phone.'N//o�,.�,
Address / 2
City: /() /la Stat
Zip Code: "3��/+�Fax: _
Phone No. _�i��/79 �S"9� 10:
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Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPpCEMENT tL C I TRUCT1®N LIEN
LA1%if IN
QRIyIATIO>4 r '7 n Frv`
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: Al A
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 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
s Signature of Owner/ Lessee/Agent
STATE OF FLORIDjjy�� /� . _ ,
COUNTY OF // ��'�`
The for oing instr t was acknowledged before me
this i9 day o 20 /,S:_by
.l 14?1— Cl� S
Signature of Contractor/License Holder
STATE OF FL A�j
COUNTY OF� teae_—
The forgoing inst t was acknowledged before me
thi�5day ofp 20 !-j by
4&� -� ��
[Ka mmejo�f person ackn/o ledging) (Name of person acknoweedgin )
,,
(Signature of Notal,,blic- State of Florida) (Signature of Notary Pu ic- Ifate of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produ ype of Identification Produg94..,.,,,,_
Commission No.
Revised 07/15/2014
FRANCES DONZA:'•"• an.;;.:gONZA
(lMISSIONCFF014070 Ilommission No. (Sea
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01flES: July 27, 207 w„.¢d7
,2017BondedTWu NotaryPu611d underwriters
REVIEWS
FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVI W REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS