HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-'r
ALL APPLICABLE INFO MqST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Nom- SCANNED
Building Permit Application BY
Planning and Development Services St Lucie Counti,
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
1'piqnphuh IMPRhVFM_�NT`f'h(.hYInN'.�
Address:
Legal Description:
:Z (,0(0 4- L) A/ Ir 17-S ( c) eZ 3351 1-7 1
Property Tax ID #: ?15;9-9 400-) _6019 Qq� Lot No.
Site Plan Name: ��16 R-N 51z�� Block No.
Project Name:
Setbacks Front Ht+- Back: ___kdL_ Right Side: r4A Left Side: f—[&
I DETAILED -,DESCRIPTION OF.WORK:'17-1.,
k NVO LA)
Z/12VI'4/, &,;177Ad -Qhr7XJ
I.C-O'NS'TRU,c,-r,iONiNFbRmAfld,N'i-,.,
AaamonalworKlOcie errormed unaerfruspermil check all apply:
11H`VA Gas Tank DGas Piping Shutters &Indows/Doors
11 Electric Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: S Ft of First Floor:
2(00— In Sewer Septic Building Height: U0
zo
Cost of Construction: $ Utilities.
O�YNER/LESSEE:
-CONTRACT 411:�:
Name
Name: 1111f
Address: C kow p/&
Company: -0.4"d
City: State: FI�
Zip Code: Fax:
Phone No.
Address: /V,4/
Citv: (:?-kA�t r—
Z'ipCode:-
PhoneNo. f"n-nng)
State:,
Fax: 61 -4 -5 -7 -7
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 4 6'ao'
AC-0
State or County License-
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SlUIP,PLEMENTAL CON �TRQC�,�19� LAW-INF, ._,MAT1ON:1y
DESIGNER/ENGI NEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone:
State: —
City:
Zip: _ Phone:
—State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con4ict 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 f rom 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 fpilt)re to Record a Notice of Commencement may result in your paying twice for
improvements to yo r lolpi 9 Notice of Commencement must be recorded and t don the jobsit
f r:r pos e
I e
0
rey
)r fpil
b%=rthE I intend to obtain financing�, �cult ry
e Vo nt /n attorney before
co e c W5 vour Notice of Commence nt
- Signature of Owner/
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ':� 7- IUC-12'_-� I COUNTY OF <�� 46)r_/z-777
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisc;gadayof 20/,I--by I th!E;� day of T_0Wz_' 20 16 -by
(Name of person acknowledging (Name of person acknowledging I
'(5IgnbtuTeVf Notary Public- State of Florida (5iinatur-e-Of-Nutary Public- State of Florida I
Personally Known 6,'� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.
# FF 173907
Revised 07/
Commission No.
FF 173907
er7,2018
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