HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FO)t,�{fRPkICATTIION TO BE ACCEPTED
Date: — ��(0 BY Permit Number: \ro0 �'d \c
1111111kSt. Lucie County
Building Permit Application
Planning and Development Services
Building and Lode Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
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: r� Y1PS J
Legal Description:
Property Tax ID #: - d — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: 41H
❑HVAC u Gas Tank []Gas Piping
❑Electric ❑ Plumbing []nprink
Total Sq. Ft of Constructiono( b G,NI�'eo_
C7C�
Cost of Construction: $ .
Shutters ❑ Windows/Doors
❑ Generator' ❑ Roof
S of First Floor: Ft.
Utilities: Sewer ❑ Septic
Building Height:
OWNER/LESSEE:
CONTR CTOR:
Name �w0 , '
Name:
6
Addr s S
Compan : vc
City: en n State:
Zip Code: Fax:
Phone
Address i ; SVkij
City: \'-'OA cz� i�e State
Zip Phone No �_ T)-. _I Fax:
Phone N`o'"-1-17'-' L{�1 - 11-1 S _
E-Mail:
:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Ybsc�b •Yn D rr3 2! M , CO -�
State or County License.QaIZ6W'3SD
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/EN
Name: 2M
E
_ Not Applicable
MORTGAGE CT/ANY:
Name:
_ Not Applicable
Address: JIV
I I
Address:
City:
Zip:
Phone:
State:
City: IfState:
Zip:
Phone:
FEE SIMPLE TIT
Name:
HO DER:
_ Not Applicable
BONDING CO�QP,
Name: d I
y I
T
_Not Applicable
_�
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
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
STATE OF FLORIDA 1
COUNTYOF 5k.
The for oing instrument was acknowledged before me
this May of 5 a r . 20 \!�_by
STATE OF FLORIDA
COUNTY OF S-'•t-yc\'k,
The forgoing instrument was acknowledged
before me
this Al day of �tl !� 20 -10_ by
0C% �'I V%pCP%S 1 \Jder3 Nf\orr�_:s
(Name of person cknowledging) I (Name of person cknowledging )
Personally Known OR
Type of Identification Prow
y pv`l
Revised 07/15/20114-17-v
Notary.,,r,,�, ��.-Pins Deo 18761 1
MY Come s on1 . nal Notary �
(Signature of Notary Pu lic- State of Florida )
Personally Known- " OR
Type of Identification I roduf3
Commission No.
Notaryr,rr' State of Flonun
My Co rh } Tres Dec 16, 2016
Commission # EE 858761
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