HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COM''c2 ED FOR APPLICATION TO BE ACCEPTED 1
Date: en Permit Number:
----------- SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
- Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ' ^
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial D� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address: 7 /H.,`,
Legal
ra
PropertyTaxlD#: 3�103 ^SOZ- OD SS-Oo0^7 Lot No.
Site Plan Name: 1X i Z✓= I2uo-a( Block No.
Project Name: Al -
e- 7-/'1
Setbacks Front 9 ' Back: Right Side:
DETAILED DESCRIPTION -OF WORK:
Rom- vim, ��-.w--
o
Left Side: y°__
0. 45. ,N27t,� 494J
CONSTRUCTION INFORMATION:
AaanionalworKtOpenertormea under tispermit-check a appy:
OHVAC Gas Tank ❑Gas Piping _Shutters �Nlindows/Doors
Electric 0 Plumbing []Sprinklers Generator g Roof
Total Sq. Ft of Construction: ;2-0 sP" Sq. Ft. of First Floor: _
Cost of Construction: $ OD7J Utilities:LJ Sewer 0Septic
3Yz
Building Height_
OW N E RAESSEE:
CONTRACTOR:
Name $T -
Name:
Address: 3 7 ( M,`ct/ c✓ay %Zo
Company:AaN lAak-�
City: F?- D i __ c-c_ State:
Zip Code: 3 `Yff P"z-- Fax:
Phone No. X 722 - T�i f —6 �f30
Address: Ziay s -S, 9D, raw 4c`✓u
City: F> 81,&cc^ Stater
Zip Code: 3 �%9� Z— Fax: 77s - YG7-/31%
PhoneNo.772.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: -we7
State or County License: 03 %O SSG
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI
IEN LAW INFORMATION:
DESIGNER/ENGINEER: _
Name: sV��j—
Not Applicable
MORTGAGE COMTY: /
Name: , 4 �I nuaz-
Not Applicable
Address:
_
Address: oTc. G
/4-r
City:
Zip: Phone:
State:
City: c—
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name: C
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address: i
Address:
City: Ir
City:
Zip: 3ef-2, 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
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.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORID
COUNTY OF._
The forg ing instr ent was acknowledged before me
` thisPa=•• of 20 -6by
I I n
(Name of person acknowledging)
f Notary Public -State of Florida
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/20
DAWN MILONE
No(Ifga )Able - State of Florida
My Comm. Expires Mar 22. 2017
Bonded Through National
STATE OF FLO !%
COUNTY OF _�1 ,P
The for Ang ins tru nt was acknowledged before me
this day of 20 /—by
Name of person acknowledging)
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
--P Type of Identiclui% fication Phodu4e'd .1__.e. '.
PA i, iUAVVN MI.,,,,:
Notary,
Commission No. �ypJ� Stale v Florida
MY Corthh. ixjres M- '2, 201i
,Fa.r.o�„ Commissicr S71
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