HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 0 15 BcANNED Permit Number:- y2-0
BY
• fit. Lucie Counl,v
Building Permit Application
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 Residential -
PERMIT APPLICATION FOR: "J:-lion III
I PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description:
PropertyTaxlD#: ')4UD
Site Plan Name: Li IMP r
Project Name: 1' ( "L
Setbacks Front >94"'
15Le-ioo-
Right
4
Left Side:
Lot No.
Block No.
DETAILED D8CA10TION OF WbRK`. I �'-J ®4� III
Co•VSTR�T LyYMNAStuM EYRA 5ZOQ raR Ftla
aEr.Ecr�w SaP��azt ps!iLrt.�
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I CONSTRUCTION INFORMATION: III
_ HVAC _ Gas Tank —Gas Piping _ Shutters
Windows/Doors
_ Electric _ Plumbing _ Sprinklers 2 _ Generator _ Roof
Total Sq. Ft of Constructio g�ss •F'`r�q� Sq. Ft. of First Floor: QP?6-6
i
Cost of Construction: $ Utilities: Sewer
1 _ Septic Building Height: �a
OWNER/LESSEE:
CONTRACTOR:
Name L
Name: Kekho
Address: �(Q(Ww
1 i IY w ao Ka.
Company:
i l: VLS -
City: P i e trce State:(--L-
Zip Code: �+} I Fax:
Phone No. —q k Z 3 1
Address:
r
City: I i cit. State:L_
Zip Code: 4" N Fax:
Phone No. 772 — 1(0 —
E-Mail:.//�EiPTy A Gy ie2� '4� •
Fill in fee simple Titie older on next page (if different
from the Owner listed above)
E-Mail: NL1 L- K. fIC-S l_ G dAA i L. CO M
State or County License: CLyC 1 -b -1 ! J
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If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: 01
DESIGNER/ENGINEER:
Name
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:_%(o 1 ] SW —
rs LUt
Address:
City: �+7Aa Ili -I
Zip:9)ff:2�:1_Phone: 1]2-L2rJ::-4cf`10
Sta —L
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
of Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 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 cohsideration 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 concurrencV 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
—Signature of Owner/ Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF !�- COUNTY OF .
The forgoing instrument was acknowledged before
The forgoing instru nt was acknowledged befoP Lw.k�ry"e g g g
this day of � 20/�by ` this �Uday of �z .20�by
11
person
Personally Known I
Type of Identification
Commission
Revised 07/15/2014
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ri! �...� _� .� � 55{{
(Name of person acknowledging)
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State of Flo a)
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(Signature of ary Pu ic- State dFlor
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OR Produced Ident" cati
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Personally Known OR Produced
iced
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Type of Identification Produced
Commission No.
(Seal)
(Seal)
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
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