HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONt
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNEBarmit Number: /5 D :
BY
St. Lucie County
Building Permit Application DECEIVED
Planning and Development Services MAY 2 2 2095
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: To Select from dropbox, click arrow at the end of line
PROPOSED_ IMPROVEMENTLOCATION;,
Address: • re S, L.3y95.2 '
Legal Description:
Property Tax ID #: Lot No. 1�
Site Plan Name: I Gt e/ Block No. 2�—
r
Project Name:
Setbacks Front ack: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit—Checka apply:
❑I fiGasTank ❑Gas Piping _Shutters ❑Windows/Doors
ectric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 7 lv a 0. 20 Utilities:Sewer ❑Septic Building Height: ZG I2 '
OWNER LESSEE:
CONTRACTO :
Nam
Name:
Addrenss:
Company
City:F�. r. L . State:
r— —
Zip Code:J!J 9 5�� Fax:
Phone No. 77e2_ —AD If7 <6
Addres
Ci Ge-
Zip Cod
Phone No. ra
State:
Fax: Ile L/5
/
E-Mail: 'r
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail — S 2
r
State or County License:O
S !t 7D Y-" /J57
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN' LAW' INFORMATION: III
UCJIl71VC CIM41 t :K: Not AppIIC2Dle I MORTGAGE COMPANY: _ Not Applicable
Name: �i�ret rI Prr� �� Name:
Address:/�i)di'Address:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
City: State:
Zip: Phone:
Not Applicable I 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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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 vour Notice of Commencement_
_ Sign lure of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF -Ain.
The foflgoing Instrument was acknowledged before me
thisdayof Lj�20�by
,WrsR—nally Know OR Produced Identification
My Commission ES 159114
07/15/2014
Signature o Contractor/License Holder
STATE OF FLORIDA
COUNTYOF
The fo going Instrument was acknowledged before me
this day of by" 20 K by
II OR Produced Identification
Type of lclgntifjc�tiprR P_rQftucL _ _ _ _ _ _ _ __
Nom" Pcb;, Stare of
My Comm.svrn Et ISb f14
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