HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i `-2,0 Permit Number:
—. : SCANNED
• RECEI`.'-D JUL 3 0 ?215 BY
Building Permit Application St Lucie County
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
r
PERMIT APPLICATION FOR: T. Selbct.from dropbox, click arrow at the end of line
PRr1P(1rl611 IMPRr1VFKAF.NT l'f1r2ATinN
Address: J /
Le al Description:
X 7 Z-n 1-1
Property Tax ID #: 'Jw`I - ,?Li _ C'_JI "CA-U- I Lot No.
Site Plan Name: 1. I. I Block No.
Project Name: l 0 t k �1d2 +-k-
ti'•
Setbacks Front Back'. 61! Right Side: Left Side:
DETAIL'•ED DESCRIPTION OF WORKt
C_UA)3i l�A I d r 10 `x t O V U6 n v' Lo
I2 � I vk �;gcizjl-bd •WI c�v�te-ta. 5-la•-b
,4 , �,
(-CONSTRUCTION INFORMATION:. _s.III
LJHVAC L I Gas Tank UGas Piping LJ Shutters
11Electric 0 Plumbing ElSprinklers E Generator
Total'Sq. Ft of Construction: 1 S Ft. of First Floor:
Cost of Construction:$ r Lol l Utilities: Sewer OSeptic
❑Windows/Doors
gRoof
Building Height:
OWNER/LESSEE:;
CONTRACT R:
Name
Name'
L Q
Addres '3\I T
Company:
K-C
City: I'eN i State: _
Zip Code: 3(i Fax:
Phone No. `Roof- �nl $ #
Address:
�Q VOL
City:
Zip Code: 6 9
Phone �0 '
,S/tote:_
Fax: IOY"%
z
E-Mail: ld (Xa
U
Fill in -fee simple Title Holder on next 'page ( if different
from the Owner listed above)
E-Mail: 'Myl&"
_I O~ a o . Ltry l
State or County License,
I If value of construction is $2500 or more, a'RECORDED Notice of Commencement is required.
RECEIVED JUL 3 �; 'i15
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a
SUPP;LEMENTALCONSTRUCTIONTIEN LAW INFORMATION :
DESIGNEFMIP E W^
Name: '1C
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 'S v`aia
1 Y
Address:
City: State:
Zip: Phone:
City: State:
Zip: 1044L4V Phone:
FEE SIMPLE TITLE HOLDER:
Name:
'Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure. Please consult with your Hlome Home
Asso iation andrreviebylaws
your deed for any restrichtions which may applyhibit such
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
rnmmpnnine work or recording your Notice of Commence nt
Owner/
STATE OF FLORI�A STATE OF FLORI
COUNTY OF t-T La A '( w D COUNTY OF - U.tC-O
The forgoing instruipenj was acknowledged Ilefore me
this _[U day of `M . 20 Ifaby
person
of Notary
Personally Known v OR Produced Identification
Type of Identification Produced 7
Commission No. � �0/6-70'�(Seal)
Revised 07/15/2014
The fling instrumeyt w acknowledged Wore me
this "day ofygld , 20 by
(Tgamg of person accnowledgin
(Signature of Notary Publi -State of Florida v �$
Personally Known OR Produced Identification f
Type of Identification Produced
Commission No. EE�I(Seal)
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