HomeMy WebLinkAboutBUILDING PERMIT APPLICATION772-801-5398 P.1
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
/ 1� Date: SCANNED Permit Number. .Z% LJ to(
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• St. Lucie Count%
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--- ._ ._. _.�.. Building Permit Application DEC 2 12015
Planning and Developmen t Services PERr4I77ING
Building and Code hegulotion Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982 '
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
Address: Yli6Q ALA i.n F7 I ;erc i-I-3"r,c-t
Legal Description:
Property Tax ID # • Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks From Back: Right Side: Left Side:
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Aoditional workto ,�ePe,,f orme un ert ispermrt-c e a appy:
LHVAC E Gas Tank Gas Piping _Shutters. windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor.
Cost of Construction:$_�r4ro UtilitiesnSewernSeptic Building Height:
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Name [jrNt�ia�� I e+ /Ileiri l�
Name:��rr9w
Address: Z//! 0 N 4 i A
Company: M cx-,4A; ^- A 're C( C
City: --PT P; 01 az State; C
Address: Z.?56 15-1 A -Pe -5Z
City: _Vc-l'o Oe c cn state: r-1
Zip Code: Ll 4 Fax: 7-1 Z - > KCi 519 i3
Phone No. '-? 7, • TC rq- 1/3oc
Zip Code: Zz q/ r, Fax: _272 S 3
E-Mail:
Phone No. i'1 Z - 17C-7 - rd 9
Fill in fee simple Title Holder an next page (H different
E-Mail: -IM A tT SI-AA( L 1..1 AC e�'�),w
State or County License: GA C i y7 A
from the Owner listed above)
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
772-801-5398 p.2
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MINIM
MORTGAGE COMPANY.
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Not Applicable
ER/ENGINEER. _NotApplicabley
Name:
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
no
,e the permit holderto build the subject structure
or and covenants that may restrict or prohibit such
deed for any restrictions which may apply.
Inconsideration of the granting of this requested permit, I do hereby agree that 1 will, !nail 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 additlons,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNI NG 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 an the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
_Signature of ow / Lessee/Agent Signature of Cont or/Licrense Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OFEx., ,,y- COUNTYOF�ro1 C > i ✓",—
The fooring instr}�ment was acknowledgedbefore me The forgoing instru ent was acknowledged before me
thisday of LR{¢,...,,QED 201 by this &=day of U-Ps-.v..�� . 20 L by
Q rtiol-f 7 Y-,Y1r Lke I ri: 11pi
(Name of person acknowledging) (Name of person acknowledging)
Personally Known -'� OR Produce
Type of Identification P
MY WMMIS30NffE67i°M
Commission No. �= E%P11aft- nbcria,=6
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Revised 07/15/2014
State of Florida )
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Commission No. 't�a�a meronz,�
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SUPERVISOR
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