HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:i�sl I� I i Permit Number: IS O S
RECV�'D MAY 14 ZO$
SCANNED
ow Building Permit Application BY
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 _1/" Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �1Cc%a h -I c.o llll
Address: ` j,)6 Q//� S
Legal Description: lorirm YI
(Q,lf2 hP \ r nay 1�27a
PropertyTax ID #:-S-4/&61-6N
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side:
Left Side:
Lot No.
Block No.
Muuuwnai wu[K iu ue
❑HVAC
erformea
Gas Tank
unaer mis permit all
❑Gas Piping
apply:
In
Windows/Doors
_Shutters
Electric
0 Plumbing
Sprinklers
1:1Generator
1:1Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 11 ,� C)
S Ft. of First Floor: _
Utilities: Sewer E]Septic
Building Height:
OW ER LESSEE ,„ f;ItN t� '; .....CONTRAGfOR
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Name
Name:
-r? IWIM
Addresps: I S4 1 6 V-6 Dr-4e_wo
Company:
UI
City: \ 1�?-1 I ('Q lIeR State: �J_
Zip Code: ��y/y/y� 3 _ Fax:
v�
Phone No. ' t _) —� t —M3
Ad ss:
✓ ZT e.
City: /
Zip Code:
Phone No. 4LPS '-a
State:
Fax: 1fy —'g as I
J
E-Mail: &14
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
I ` al
State or County License:
rp
\ q '.( JJlYlYOI
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
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
commencing work or recording Your Notice of Commencement.
Signature of Owner/ Agent/ Lessee
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 14 by
STATE OF FLORIgq 1 1�
COUNTY OF
The forgoing instrum nt was 4cknowledged before me
this _ day oftorl 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida) (Signatub of Notary Public- State of Florida
)
Personally Known OR Produced Identification Personally Known —A/— OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) I Commission
Revised 07/15/2014
led Intoulih N001131N
aryAlin
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DESIGNER/ENGINEER:.
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
4
Name:
Name:
Address:
Address:
City:'
State:
City:
State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 Fldrida Building Codes and St. Lucie County Amendments.
The following building permit apprications 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 FLO DA STATE OF FLORID��qq
COUNTY OF +� �e COUNTY OFi— 11G
The forgoing instru ent was; acknowledged before me The r oing instrum nt wa; cknowledg d before me
this day of �l^l 1 . 206 by this day of _, 20� by
(Name of person acknowledging),. (Name of person acknowledging )
Notary Public- State of Florida )
Personally Known —L OR Produced Identification
Type of Identification Produced
i
nal D,r D Y 6/ 0/.y7u
(sigha-tu6 of Notary Public -State of Florida )
Personally Known --Z OR Produced Identification
Type of Identification Produced
Commission No. (Seal) Commission No I f (Seal)
.. RAWIEL
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DATE
COMPLETE
INITIALS