HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
M BY
St. Lucie Countv
Building Permit Application
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address:
Legal Description:
U,6t %/ (, —
Property Tax ID #: 36 a a - (e 0 q — Co l i — 000 (D Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Front Back: Right Side: Left Side:
doors with istent replacements
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❑HVAC Gas Tank Gas Piping _ Shutters ✓❑ Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: I
Cost of Construction: $ ��. &q ,
Eli
S Ft of of First Floor: _
Utilities: Sewer E]Septic
Building Height:
OWNER/LESSEE
CONTRA O
Name 0 2i
Name: Richard Charlton
Address: 194 ZO S. 2/ C
Company:
City: State: _FL
Zip Code: 3 t•i of 71 Fax:
Phone No.
Address: 16585 106th Terrace North
City: Jupiter State: FI
Zip Code: 33478 Fax:
Phone No. 561-339-7110
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Richard@palmbeachwindow.com
State or County License: CBC059351
ii vaiue of construction is $zsuu or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTALCON5TBUGT v OMQION n ,;
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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 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 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 a first InSpectae ' tend to obtain financing, consult with lender or an attorney before
com Work or recording vour tice of Commencement.
—Signature of Owner/ Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDA t^
COUNTY OF 5 h . 1.O a � COUNTY OF`` . Y ,
The forgoing instrument was acknowledge�d,,pefore me The forgoing instrument was acknowledged before me
this g day ofJ� U tnQ . 20 L? by thhiiy�,}� day \of,, l� %� . 20 J Z by
t r �4 f A- r N S \� �Y 1„(fit ' n (1 kon
(Name of person acknowledging ) (Name of person acknowledging _
(Signature of Notary Publff- State of Florida I (Si na re Notary Public- StafeW Florida )
�Ns tai`Oa
Personally Known OR Produced I o\F q0 's y own OR Produced Identification
Type of Identification Produced �' `'t� �6\ T e of Identification Produced
SSA.
t%tyQ Er.Q`t � EE o�a�Y
Commission No. Q5 � mn`'SS\o� a�N Commisst n o. OV (Seal)
=�. Go alptoa9 ,•,.«','8�a,, JACOUELIN
Notary Public - Slate of Florida
Revised 07/15/2014 `7 ; °' ,: ` My Comm. Expires Aug 10. 2075
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bP,, Commissinn i FG 79n Ann
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