HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLI-1 =7_ i FOR APPLICATION TO BE ACCEPTED
Date: -I `;v1 1. I S ermit Number:
I RECEIVED JUL 2 7 201
SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie Countv
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 5 % I
PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description:
Property Tax ID #: Lot No.7 -1- S�
Site Plan Name: Block No. ::V—
Project Name: I' I e, IC4-) \ t !e i VY,S4tr- r-Vb.r YN 1(\i
i
Setbacks Front d V Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: III
CONSTRUCTION INFORMATION:
Itlona worKtoD[elerrormed under tIspermlt-check all MA apply:
❑HW Gas Tank ❑Gas Piping Li _Shutters ❑Windows/Doors
❑Electric Plumbing []Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $
/ �d B . Oy
Utilities:
Sewer
❑ Septic
Building Height: la
OWNER/LESSEE:
CONTRACTOR:
Name LG2 eA Z ,GLC -
Name:
Address: D -
Company:
: e
City: la� State:
Zip Code: 3 3 D ] Fax:
Phone No.
Address: 53
City:
Zip Code: fi3 9—�
Phone No. 77 - 14,'1-O'7/i?
State:_Q0_
Fax-7 -),2 - d0y-2l 5 7
E-Mail:
Fill in fee simple Title Holder on next page (if different
frorp the Owner Ysted above)
i,
E-Mail:
State or County License: a3f(N
I lue of consjfuction is $2500 or more, a RECORDED Notice of Commencement is required.
AL CONSTRUCTION-UENLAW INFORMATION:
UL51GNrK LN-INJIBM NOS AppIIC�Die MORTGAGE COMPANY: _ Not Applicable
Name: �— 3 g�1- Name:
Address* /ao� Address:
City:0 State: ") . City: State:
Zip: 0J4 � ;L- Phone:? �9-J�-�/ice Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
Zip:
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 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 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: 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 financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
ftO� v s
_ Signa 're of Owner/ Less ent Signature of C tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA� n
COUNTY OF F ag COUNTY OF CA
The for g ing instru ent was acit Nledged before me
thi ay of 20 by
Personally Known I OR Produced Identification
Type of Identification Produced
Commission
Revised 07/15/2014
Pudic State of 5tarida
-Ltamb 1S���1
nmiesim EE 159114
The fo ing instru ent was acknowledged before me
thiday of_dl20 L by
1
(Name of
ng
of Notary Public- State of Florida )
Personally Known Produced Identification
Type of Identification Producg1 . . — �AA.Ng!q!
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