HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CC:, I-_ ''FOR
APPLICATION TO BE ACCEPT
Date: -1 cm \5
SCANNED Permit Number:
@
BY
St. Lucie County
Building Permit Application
Planning and Developinent Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax; (772) 462-1578 Commercial Residential
PERMIT PPLICATION FOR: 0ofor CwtoW
Address: At -7 L? 8� Ta�SD A.) 2(7 10)&ee,45
Clq L/ 9
Legal Description:
Alwef- crif zycit aa?zler�
PropertyTaxlD#:
Lot No.
Site Plan Name: 414AW1 Owt_ WiLmom
Block No.
Project Name: (Oft SbffY OUAIJE WffL90V
Setbacks Front Back:
Right Side: Left Side:
OfhM fi 0,U) DOI CROLF01169
V&644� og WMAD&
AclaitionalworKtObeperformed underthisper
it-checka t atapply:
—Mechanical —GasTank
Gas Piping Shutters
—Windows/Doors.
Electric Plumbing
—Sprinklers —Generator
Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction:$ I&C>
Utilities: T*Sewer Septic
Building Height:
!A�IIWOVI-
41e,_
N a m'e'._&'flPAAV 4'
Ad r ss_ plf-W
Com pany: Blve &6=15c_
-
Cit A-1�11� I
-State./U
Address: �y &OWLL
57
citf.-PuT 9r,
State:
Zip Code: Y,?W Fax:
Phone No.
Zip Code: Yd� 5 Fax:
E-Mail:
Phone No- 2 7, 2 - MZ-_
9 F 36
Fill in fee simple Title Holder on next page (if diff6rent,
E-M a I I
ME)/- K!00
State or County UcenseC,#j!�
/1
from the Owner listed above)
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
MORTGAGE COMPANY: NotApplicable
S
D EPSIGNER/ENGINIEER: Not Applicable
N a m
ame:
7Adress:.
Name:
d r s
Address:
City:
C ty. State:
City: State:
zip: Phone
Zip: Phone:
FEE SIMPLETITLE-ACILDER: _NotApplicable
BONDING COMPANY: —NotApplicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AOIDVIT: Application is hereby made to obtain a permit to do the work and installation as
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 an9covenants 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, performi,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-ye'sidential 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 financin& consult with lender or an aittorney before
commencing work or recording your Notice of Commencement.
Signaturd4oft)wner/ Lessee/Agent
Signature, ldf 66ntractor/License Holder
STATE OF FLORIDA
COUNTYOF Sk-
STATE OF FLORIQA
COUNTYOF 461-1-16e%R
The Ding instEpment was acknowledge beforeme
this Xg day of 3 %) 20A9 by
The oing instlryjnent was acknowled before me
V )98
this_dayof %30k�Q by
-0-�
\-\Ck f r 4 1� Uct -Sir
(N;�� �f persorf acknowledging
(Name of persoh acknowledging)
(Signature of Notary PYblic- State of Florida
(Signature of Notary PuMic- State of Florida
Personally Known — OR Produced a
Personally Known OR Produc d n
Type of Ide ntification Ot sveN9' 1
Type of Identification DEPAr stake 01 Is
L 0
Produced— .. 9,0\r "'esDt�%10
V�y . W1.1.
Produced- . V,-L Der A -
I 11W. 15"5761
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Commission No ."to, rooS'oksl*
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Commission No. r
REVIEWS
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SUPERVISOR
PLANS
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SEATURTLE-'
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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