HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1�
AL
ALL APPLI BLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
IDate: 6 Zo i ' �51_2
Permit Number:
` ? SCARY ED
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` - --- Building Permit Application 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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
7 1 1
Address: goco Coud4±2t 1G>ri D 2 L ic4 l . Lucy. Fs -
Legal Description: q /r1 cGic4 -
PropertyTaxID#:� zZZ�U Vc�oZ.t ��%—f �I-CQC tNo.lvef
Site Plan Name: %c E65;�:V/Lw GorF � lylvr7 UrS Block No.4sa
Project Name: 44C l9G 3 i tUl4
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CowSfiuc� 2 Cd/oom/ Sl�,/S /1f Eiufcvy To 2�/�/Hcc-- o7`GiLi2c.
CONSTRUCTION INFORMATION:
rtiona wor to e e orme under t—checkispermit a apply:
� Gas Tank [:]Gas Piping Windows/Doors
_Shutters
I11'HVAC
LdTlectric Plumbing Sprinklers ElGenerator LdE] -Roof
Total Sq. Ft of Construction: 'foo Sq. Ft. of First Floor: 4&
t 2-0Septic Building Height: G _
LIT
Cost of Construction:$ Z)L Utilities: Sewer _
OWNER/LESSEE:
CONTRACTOR:
Name R
Name: IG of S Gti - S/ ✓it S
Address, 0 V1s/ h4 &1Ltrt,-_4L- /31✓U
Company:T� �c
city: [alidsau 0 ,/ qc 7Q) _ State:tVV
Address: OZS (�o i //w / I k/E GUia
City: t't�SL State:
Zip Code: B9 7b — Fax:
Phone No. 772 G C 7999
Zip Code: y G Fax:
E-Mail: A574 Fad Xiywd 49/Lt'Filti
Phone No. " 7 7 Z )^56 1�) 1 `1
Fill in fee simple Title Holder on next page (if different
E-Mail:
State or County License: C C O I
from the Owner listed above)
If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEEK: _ Not Applicable MORTGAGE
Name: Name:
Address: Address: _
City: State: City:
Zip: Phone: Zip:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable BONDING
Name:
Address:
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Applicable
_Not Applicable
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
11
—Signature of Owner/
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S¢. L-c,'e COUNTY OF 4 twoP
The fo oing instrument,was acknowledged before me The forgoing Instrurgent was acknowledged before me
this f day of A-rr� 1 . 20 L5--by this 4' day of /• / 20 L6- by
LIA Krun NNrin � een
(Name of person acknowledging) (Name of person acknowledging)
- L ax4v,
(Signature of Notary Public -State of Florida ) (Signature of Notary Public- State of Florida )
Personally Known X OR Produced Identification Personally Known _ ft OR Produced Identification
Type of Identification Produced f Identification Produced
",i'r'"'•" �NAMARIEGREEN Fv. ANNAMAF
Commission No. Fr 11�00�yIlComm(ssionftFF71206om issionNo. / 0 (:d�d�tmisslo
A. Exoires August 11, 20 8 r ` Au
Revised 07/15/2014
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