HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED gQ� I ,AIPLICATION TO BE ACCEPTED
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Date: 4 BY Permit Number:
'St. Lucie Counh/
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 C/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I PPr)pnrFr), IMPRf1\1FMFNT,I nrATION'
Address: __6 &?5-1 k�>Q6, 1`rt.e-55 k " � Ud_%L`S W-C>1 I -l" L_Lx_� U 1, 1
Legal Description: 34�L _95a_060(0 -wc> -,-A
5k- L3cv- 6u5t7v_,5S F0L L6-15 5 e-vic) & Ae-Yode 3a7r?-/F0
-Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front (00 Back: &0 Right Side: (ob Left Side: o)64
DETAILED DESCRIPTION
caywc-5
CONSTRUCTION INFORMATION, ,
AaditionalworKTODeDeri-ormed under this permit - cneCK all apply:
0HVA( Gas Tank E]Gas Piping Shutters []Windows/Doors
0_ Electric 0 Plumbing []Sprinklers ❑ Generator El Roof
Total Sq. Ft of Construction: )15(, S Ft of First Floor:
-.11 Sewer Eleptic Building Height:
Cost of Construction: $ 6 -MS Utilities 6
OWNER/LESSEE.'.;
-
CONTRACTOR:.
Name Y-t%3,zv' (er-TIL f0C_ I?S0022+tz-5
Name: ifllwjlori,
Adclress:_��i.D-C> S US
Company: C, 3L
City: Vow- -9+ bj� ' A State: f I
Zip Code: 3\11q5g�- Fax:
Phone No. 1;Q LA c)-4 0
Address: 31'&) 5f_ 151��
City: S_)IOlNe_ State:
Zip Code: Fax:
Phone No. -30?9
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
_722LI-0
E-Mail:T�\rX5- 4_21
State or County License:
If value of construction is $2500 or more, a RECORDED Notice at Commencement is requirea -(f'
10
,SUPPJ EMENTAL C4NSTRIJCTrON.CIEN LAW>INMRlV�A710N:
DESIGNER/ENGINEER:
_ Not Applicable]MORTGAGE
COMPANY:
Not Applicable
Name: 5-� � 'm8'C�
o`Name:
Address: 1';�,?1y SO-r�i+
Address:
City: a
State: drCity:
State:
Zip: 39-)&0 Phone: `7
-S a-'f000Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
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 prty. A Notice of Commencement must be recorded and ed on the jobsite
before the first inspeo6n. If you intend to obtain financing, consult with lender n attorney before
Lessee/Agent
STATE OF FLORID
COUNTY OF
The forgoing instrument was acknowledged before me
th`32>day of T'N o! 20 Eby
G�a`�l�raY. rt( o..fe4 S
(Name of person acknowledging)
Y
State of
Personally Known OR
Type of Identification Product
Commission No.
Revised 07/
01
STATE OF FLORIDA
COUNTY OF \.JC\f
The forgoing instrument was acknowledged before me
this a3 day of YYN 4 i
20 A�-_ by
C\o,•t�a-n-CiaJetS
(Name of person acknowledging)
(Signature of Notary Pdblic- State of Florida) stvENs
EANNP otF\ocida
Personally Known oduced 18� ,i,Re 01 20t
Type of Identification rode° e',� t4do xoF o 05 -g 17V
S ..: MY C "wan Notary P'
Commission No. 'E S i , C° p�j�nNanonal
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
1 1
INITIALS