HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABV INJO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: + �� SCANNED Permit Number: ��' naq
BY ld`(qunooelonl'IS
St. Lucie Countv ONIl MURd
Building Permit Application 510Z ` 6 gnd
Planning and Development Services ,
Building and Code Regulation Division ®� �� oA�y
2300 Virginia Avenue, Fort Pierce FL 34982
31
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: %.( 06) __�) 04
LegQ Legal Description: n4
gap
Property Tax ID #: 14'.50-q- �P
Site Plan Name: 6 tw R
Project Name: u.N
Setbacks Front Back:
✓pie - Si��P A
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
SD vEf,�/ �� //i,t1� �o N a
7 �i � �j P1iG �r�t 2 /n /7 � 91 /1Vw /./a T. a_A
CONSTRUCTION INFORMATION: I Ill
LJHVAC "Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
.¢I IuL—WMLn mt appry.
11
Sas Piping _Shutters
Sprinklers 1:1 Generator
S Ft. of First Floor: _
Utilities: [Sewer Septic
❑Windows/Doors
Roof / V/
Building Height:
OWNER
Name f J
Name: >v�o6kl;
Address: c v<
Company: c OoY4= jz
City: 1ZA6 A State: (-6�
Zip Code• Fax: 772 -92912%
Phone No. 3
Address: PO PsX 73 )1
City: . )�iNjSp1 State:_L__L
Zip Code: ?q9 5� Fax:
Phone No. 772 5�0 0E,5`1
E-Mail:�lYl iPe it/ ® ,4
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:6)Tls� C , cQ,M
State or County License: C G C i52_0SX9
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
LIEN LAW INFORMATION:
Ut:WU[Mt:n/ttv113tfvttn: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I 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 recordingyour Notice of Commencement.
s
_ Signature of Owner/ Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF NR I �✓y
STATE OF FLORIDA
All P_�/l/
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this // day of A UGC s 20 15 by
this // day of 111!/4-�U 5% 20 IS by
66�16&_
'4�rzjwv Cm,'-5
(Name of/person acknowledging)
(Name of per/so)�n acknowledging)
(Signature of Notalry Public- State of Florida )
(Signature of Notary Public- State of Florida)
ersonailgKnown RYroduce&Men t tcaLon=-
-Person lly-K-no—w-nR uce ' entt icatton=
TypeofIdentification Produced nn -L11
Type -ofidentifica6m Produced- L u
Commission No. )YISAW)IERMES
Pu®flo - State of Florida
Commission No.
,o��;^��.,,� CINDY L A CH ES
UM 1 FF 240313
=':°` `�ti Notary Puole - State of Florida
"�, My Comm. Expires Jul 6, 2019 Geelrn1i6W11 P r� +�..�- II
Revised 07/15 d2Botdtltlaattat li t•ialWary Assn. P ' My Comm. Expires Jul 6, 2019
anndedthrough National Notary D.ssn
REVIEWS
FRONT
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SUPERVISOR
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VEGETATION
SEATURTLE
MANGROVE
COUNTER
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEVY
DATE
COMPLETE
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INITIALS