HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�Y SCANNED
4. BY
St. Lucie County
ALL APPLICABLE INFO MUST BE COMPLETED TO BE ACCEPTED
Date: 5. 7 2D� S Permit Number. I �
ID (2-15
Building mit Application
Planning and Development Services
Building and Code Regulation Division
23W Virginia Avenue, Fort Pierce FL 34M
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential
III PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line III
Address:
Legal Description:
F
Property Tax lD #: 140 6.4-,� 2C00 3 00o b Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Frorrt Back: Right Side: Left Side:
AVD �tc,t.�a-{a ��ce 13Lri brim
E]GasTank E,asPiping
❑_Shutters QWindows/Doors
11 Plumbing []Sprinklers
❑ Generator
Roof
Total Sq. Ft of Construction: S Ft. of First Floor.
Cost of Construction: $ SO p: eb -- Utilities: Sewer QSeptic Building Height: AL
Name Orl h
Name:
Address: f,0CtVI V. W:P Ow
Company:
City: *r-l- nage State:;
Address: T, b AM
471ZI
Zip Code: VtONtO Fax:
City:
�/ Stater
Phone No.
Zip Code: -9
Phone No. 7 L
E-Mail: d6P eof-
,))Fax:—m
y8
E-Mail:
Fill In fee simple Tide Holder on next page (if different
State or County Lice
C f?17 PJ 4'Z
from the owner listed above)
If value of construction is $25W or more, a RECORDED Notice of Commencement' is required.
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u
DESIGN /ENGIN ER:
Not 6p licable
MORTGAGE COMPANY: _ Not Applicable
Name 2
1
Name:
Address:
Addresk I o AVel IL
2r-
City: State:
Zip: Phone:
City: 1 ii v+ (fie r- cc- State: F
Zip:a4olSa Phone:772. yw4 Zoto
FEE SIMPLE TITLE HOLDER:
%Not Applicable
BONDING COMPANY: _Not Applicable
Name: Ocy6,q gh"nL
Address: J joo Colo. n*,,,6
LN IU4
Name:
Address:
City: Fa-k Percy
Zip: 3gA•]A Phone:
rl
City
Tip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
St. Lurie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structur
which is in conflict with an�r applicable Home Owners Assonation rules, bylaws or and covenants that may restrict or prohibit sr
structure. Please consultwith 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 1 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
STATE OF FLORIgq STATE OF FLORID
COUNTY OF fit- l afL�P COUNTY OF
The forgoing instrument was acknowledged before me ED The forgoing instrument was acknowledged before me
this ll+i.day of� 2015by EytL this _ day of 120_by
(Name of/%p/_erson ��/art\�\4owledging) (Name of person acknowledgingg n /]
(Signature of Notary Public- State of Florida) (Signature of Notary Public- tale of Florida ) '. \
Personally Known OR Produl Identification ) Personally Known R Produced identification
Type of identification Produced t lam- Type of Identification Produced
C DAMS .�,�C^'•�., CONNIE R
Commission No. F�10 Commission No. EE��r]3� �° = Notary Public - S of Florida
OTARY PUBLIC fAy Comm. Expire ul 29.2016
STATE OF FLORID ';", Commiesbn a 209535
Canm# FF108235 "• " "" BotMed Thmupb Nati Notary Assn.
Revised 07/15/2014 Expires 3/31/2018
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