HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9,:N \1 V5 . Permit Number: 6(�)
SCANNED
BY RVEIVEDJUN29`20
St. Lucie Coun v ta_2
Building Permit App ication .0
, 03
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
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 0 A I
Address:
Legal Description'.
Property Tax ID #:
Site Plan Name:
Project Name:
3 2 A/
— 1773?—
002 5— 01,0
—,3
Setbacks Front Back: _ Right Side:
lice) -R
Left Side:
CL-tA 9
11HVAC U Gas Tank, 0Gas Piping Shutters
[RElectric EPlumbin' []S - priniders 00
i - Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: Lltili�ies: ElSewer E Septic
I All -
Lot No.
Block No.
vzc,�, CA,-
E]Windows/Doors
koof
Building Height:
E , E SE
Namej 417
Addres�:";Z90-')�3
Company:' SS 0
C_� �T�4 C,
City: St,t,-.,7\J-rV
Zip Code: -Fax ._J
-q
Phone No. 5�1
Address:
City:
Zip Code: Fax:
Phone No. 1- 777- ff 7:3
State:
7 -
- 5-2- Lk-'3-
E-Mail:—
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
_6W 7
If value of construction is $2500 or more, a RECORDED No.ticeof Commencement is required.
Name:
Address: -
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: —NotApplicable
Name:
Address:
City:
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 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, 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 r I evi . ew: 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 aRain financing, consult with lender or an attorney before,
- SignaturA of Owner/ Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDA .
COUNTYOF 'Sk. — I COUNTY OF 6-�� 1-1,1 c.
The forgoing instrument was acknowledgedbefore me The forgoing instrument was acknowledged before me
this-ILN dayof �5N) 20 ��_by this Qek day of S U ^A 20 \5 by
-56\,A R 0'r �4 1, -Inv-o' `ii\)fAJ
(Name of person acknowledgiig I (N�me of person acknowledking
(Signature of Notary Pub\lfc- State of Florida (Signatu�re'�_,of Notary Public- State,of.Florida
GVvENS fida
Personally Known ro uced I agge At Flo Personally Known OR Produce I n
Type of Identificatio Pr 3 -1.
Dec Type of Identifi
comm. 6^0S 4t EE 85510 Po�blic - st2te'al Florida
tion.00a" Commission IN tary
Commission No ;orrrr.EAk&l)ecl6.
Cornmission EE 858761
%,innal Notary Assn
Revised 07/15/2014
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