HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: {p. i a )— MANNED Permit Number:BY
yw of Lucie County
o _
RECEIVE®
Building Permit Application
Planning and Development Services JU� 6 2��5
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
Address: TlAizn n j !( p, Feccl er I0lSaCJ
Legal Description: !Sac- GTTGtC'lPd
Property Tax ID#: I312 - L[ZZ-000Qo -o%
o-Lot No.
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Site Plan Name: Gt,, ax� &rk Un I4ed Ole*b[ jis+ �
ci u ish Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Total Sq. Ft of Construction: So. Ft. of First Floor:
Cost of Construction: $ a� �� �U, O O Utilities:Sewer oSeptic Building Height:
Name 4 h& M P /
Name:
Address:
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Zip Code: `?S Fax:
City: y@ j 'JpC C,h State:_EL
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Phone No. y6s- //5/7
Zip Code: 3Zri 6aP Fax:*1-777_-299-3IRO
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail:
State or County License: L4 Frz (
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPE�EEMl�UTAL CONSTRUC`fl N LIELV [AIV' NFOFtN1ATl04i
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DESIGNER/ENGINEER: Applicable
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Name:
MORTGAGE COMPANY• Not Applicable
Name:
Address:
Address:
City: State:
ZIP: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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 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
structure. Please
or prohibit such
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 the Florida
plans, 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
comme cin work or recordingour Notice of CommencementAATEOF
Lt,..K.,,.i
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Sig lure of Owner/ Agent/ see
ntractor/License H der
ATE OF FLORIDA
ORIDA
COUNTY OF Tnci1cLn Q J e. r
COUNTY OF -ndi an
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this —LLtLday of 'Tu n. e, . 20 _Irby
this JJ_!—d+.Pa�y of :na n p zU��y
T f�
l QL'N1f S 1NAWL 1 S
]C�m E IUufJ� t S
(Name of person acknowledging)
(Name of person acknowledging)
�i—e 1 n a.S �l �� A n..
I . e G dl
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commissi
A 6. DUBk�
Comm iss 1-110
►oYYe , tab of Fluids
TERESA G. BUREN
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Revise
My Comm. Expires Jul 2112016
Commission ♦ FF 115616
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