HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-'! 15 PermitNumber: ml-G-a`il
RECER I JUL 23 M
Building Permit Appi I ication 44003 e;3nl -�S
Planning and Development Services (13NNVOS
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
PROPOSEP IMPROVEMENTLOCATION:,,,''-
J, 3,
Address: 10soo ocew Dayr- t-Tgl�f" Egog�44 I PL,
Legal Description:-TU41-1Z fOaF to,-001M INIUA' 00C �PYVITS" Cl �hL 02.0 C arvils
Property Tax ID 4: "f % it -ml - ot) - Of ;I Lot No.
Site Plan Name: 1213�2 CA2'V00 Block No.
Project Name: 12ap
Setbacks Front,� Back: Right Side: Left Side:
F�ETAILED DESCRIPTION OFWORK-�
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FC04ii!RUCtIO N,I N FORMATION:
AdclitionalworKtoneDertormed
HVAC
E]Gas Tank
underthispermit checkall
0Gas Piping
apply:
M
— Shutters
11 Windows/Doors
Electric
Plumbing
[]Sprinklers
ElGenerator
11 Roof
Total Sq. Ft of Construction:
S )Ft of First Floor:
an
Cost of Construction:
$ 4r4
005) Utilities:
Sewer D Septic
Building Height:
WILESSEE:
-OWNE�
CONTRACTOR: -
Name_-1_LA&rLPr- aga--., i%al'on :JE: //VC,
Name: 6iwo�A
/01 k- I
Address: /08\-')O �< nrt� O&L&__ (4k?!
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Company: 7��bv §Qzr-�
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City:�:� State- iF
Zip Code:-2 qI K -7 Fax:
Phone No.
MUU[Cb ty�y =tz
�14
City: - "Ovmir=
ZipCode: Fax:
Phone No. 7- -,Otpq 0
state:
V/ ce-te,
E-Mail:-
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E-Mail: 4nQ1r41,A&
WZ&IDA
State or County License:
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
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: —Not
Name:
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 co ixict 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 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: Y r f9ilure to Record a Notice of Commencement may result in your paying twice for
improvements to your p y. Notice of Commencement must � record
�d on the jobsite
i n Alovintend to obtain financing, con5aft�mijh le e mey before
befo,p6T%e fif4t inVe��
—Signaffure of Owner/ Less Signature ot Contractor/License Holder
STATE OF FLORIDA C� STATE OF FLORIDA
COUNTY OF -G7- / 12C 1,—.c COUNTYOF S7-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thijs;�day of _U_OZ�X 20/
d-by thi�,��ay of 20 lfl;r- by
(Name of person acknowledging) (Name of person acknowledging
(SignatluTeW Notary PubTic- Stat�rof Florida (Signatur��Notary PublicState of-Rdricla
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.
My? , AMISSION # FF 173907
D -s:Dwwhar7.201F
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