HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONC
All APPLICABLE INFO MUST BE COMPLEI'-_. i OR APPLICATION TO BE ACCEPTED
Date: $ �-=' 1S Permit Number:ys c� -o aq j
RECEP"Ll AUG 0 6 2% SCANNED
BY
St. Lucie County
Building Permit Application
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
PERMIT APPLICATION FOR: L
PROPOSE-D IMPROVEMENT LOCATION:
Address: 10(a&> S' (9CPcv, 0,00t, 7�tn P6r /� U9rj
Legal Description:
Property Tax ID#: 1 r Rnii-1 / 1 '151k - S�eo1 64:�)(30—a(�4-5 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
r
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 2 <
_ Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
/LESSEE:
0 W N ER1
CONTRA/1GTO)R:
-E
NamdZ5_W l refit- Ca"Dnminy ✓n kisbir
Name:
Address:10680 in,riL /�2r'Pn. DizlvQ
'Company: Li Aev,It
City:.y -Aro4 Stater:
Address:' a 9-7
City: % i /1�9,---
State:_4L1
Zip Code:.? Fax: 77Z'Z29-c96Sd•
Phone No. 77 - 9—t•8g-]
Zip Code: .3 Y-9
Phone No t7 7) r3 ?i
Fax:
E-Mail: TS rLe 7: @ QB �. ' 43
Fill in fee simple Title Holder on next page (if different
E-Mail A c rn C nc)
�• � �� r�
State or County License
--
from the Owner listed above)
a5-a
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU RLEIVIENT CONS
QN U IN
ORM 0 .
DESIGNER/ENGINEER:
Name: tik 4- 142 e-.n
_ Not Applicable
e< rc,L
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
_e<„-e_
Address:
City: ere.2
Zip: 3 ST,, r� n Phone '7
State: JEe,
i Z !4(n 1? 17.5 (
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencinifwork or recordine vour Notice of Commencement.
Signatu Ow essee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF _5r
COUNTYOF Sk. LJct�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this,�dayof_ Qvot,,%z 20_by
this day of 26\5 by
(Name offpdrson acknow edgin )
(Name of person acknowledging
(Signature of Notary Public- State of Florida)
(Signature of Notary Pub' - State of Florida )
Personally Know OR Produced Identification
Personally Known'' OR Pro u rpI�n1s
Type o Identification
T e of Identification DEA gtate of Flon
PubE%Pites 16, 2016
L'�
Produced DIANA1 MANN
duced .°Pa""�i?'. Notary Dec
3x • • Commission EE 858761
-,.„„%.�,y''':.z MY rAMMISSI0IN 9 EE 22074
Commission No.�(: tj ?,�. �6XPIRE6: October 27,201
'•Ppf fl, �hEed Thm Notary Public Unde
. MY #
C mission No. a` Co National Notary Assn.
ers
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