HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: I J71o9 -e'i �4
Building Permit Application SCANNED
Planning and Development Services BY
St. Luce County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 y
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential �\
PERMIT APPLICATION FOR: To Select from dropbox, click here /�,O_iy,., III
PROPOSED IMPROVEMENT LOCATION: III
Address:4580 SOr1771L Oc451AJ 2)R fi 'PiERaE FG 3V-A�7
Legal Description: S C220, dF AI lady/661% 4M �K 5&,q//6AJ 99 7W? 355 oVY 6-
Property Tax ID#: A5,Z? - 3V-3- 400.3^000%5 Lot No
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
/srt�
Block No.
CONSTRUCTION INFORMATION: III
�HVAC Gas Tank ❑Gas Piping u Shutters ❑Windows/Doors
DElectrlc Plumbing Sprinklers Generator Roof
i 1
Total Sq. Ft of Construction: �/ n�Xa X % CLLr tINNS S Ft. of First Floor:
Cost of Construction: $ o2� DQ0 Utilities:�Sewer•�Septic Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: 4so $. OC$94J OR
Company:
City: —)V7!P/EQ0I; State:4 C-C_
Zip Code: _?V90 Fax:
Phone No. 96�jX-0.3//
Address:
City: State:_
Zip Code: Fax:
Phone No.
E-Mail:3[r/J7111VU)CffM&J55@AW.40,M
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION -LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Not Applicable I BONDING COMPANY: _Not Applicable
Name: _
Address:
Zip: Phone: I 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 angcovenants 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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/Agent/ Lessee Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of . 20 14 by
STATE OF F6GRIBA A441611 ynR
COUNTY OF 7:USCALtbSA
The forgoing instrument was acknowledged before me
this Mday of i9uauJst 20—jg by
1I de/nfOn C6Qa,61tS5
(Name of person acknowledging) I (Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced Ala 6n.tia< Q L
Commission No. (Seal)
MY COMMISSION BLOM 1610ICH 7.2018
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