HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPI °D FOR APPLICATION TO BE ACCEPTED
Date: 3`\O' \ 5 Permit Number:
REc&V cp MAR 10 2015
Building Permit Application SCANNtu
Planning and Development Services BY
Building and Code Regulation Division St. Lucie C01InT
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial_ Residential
PERMIT APPLICATION FOR:
Address:6CA (J • PL p,C�
Legal Description: 36- 3`f 40 PaQr of kZS. b3 f4UZE5 w SkFUCwN5 3'{ .4AJD es- 34 Yo a-S /,U neic
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Property Tax ID#: lY3,f7_rm O&V2 rorV-7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be performe un er t is permit- c ec a t at apply:
_Mechanical:' _Gas Tank Gas Piping _Shutters. _Windows/Doors
_ Electric _ Plumbing —Sprinklers _ Generator Roof
Total Sq. Ft of Construction: 3 U- *Sgq.. Ft. of First Floor:
Cost of Construction: $ 4S7J Utilit o
( e" suer _Septic Building Height: :�MM4_
r„„-•1-L��LOA-. �N-T� nr � '•Name:,ilr"��-•tz-'yEt�•'>�gsc-`aNCiu/ko-t
Address: 3CiCO �nunvunti�dLALT f U[� Company: [� Siot ia� sQop i,i�ru�
CI_ :=J3F61LAi "l1-SSE`E : State: -ObFf) -DT htlE
ZipCode:w7_301 Fax., city: >?tCr�GE``-•.x' State:, [.
Phone No. �)L` R7.5� lOg'D Zip Code: �cqZ Fax:�n-Nbl-(a14�
E-Mail: Phone No -nZ -a lio 80LE%
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License CCLGSSS573 (02S�(
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: —
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: KdakNArJ .
Name:
Address:ti:Ln5 L9 � ;E ciUL
Address:
City: P 5 L
Stater
City: State:
Zip:3w,g<z Phone_ `Moto _s00i
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
°
City:
Zip: Phone:
Zip: Phone:
UW NtR/ CONTRACTOR AFFIDVIT. Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifythat 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�ine vour Notice of Commianrpinpnt-
Si at re o Lessee/Contractor
Signature o r License Holder
STATE OF FLORI A
STATE OF FLORID
COUNTY OF t) L V G
COUNTY OF -��ff ,.
The
The forgoing instrument was acknowledged before me
The forinstrument was acknowledged before me
this �day of 'Maw 20�-by
this\a dayoflMa.f' 26by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Pu is -State of Florida)
(Signature of Notary tic- State of Florida)
5
Personally Known OR Produce EYG6Or" 5,
ersonally Known OR Produced Identification
Type of Identificatio �Ypubl`*pees BSBY
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5 e of Identification
Produced No��omm. SohKia�NolatYp'
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Commission No. (� `"`�
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Comm• xD St SE 655761
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