HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CONirr cTED FOR APPLICATION TO BE ACCEPTEL``
Date: SCANNED Permit Number:
BY
St. Lucie County
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
/605-0019
MAY - 4 2
Public Werim
St. Lucie County, M
Residential ' i/
PERMIT APPLICATION •• II
Address: 4140 N, 141(rNwAY Af A F /T PiecCif Ore- 3Y?Vf
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
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bA-t
onai wor)(to De
HVAC
Electric
errormea unaer
Gas Tank
0 Plumbing
uns
❑Gas
Permu-L11M& du
Piping _Shutters
Sprinklers 1:1U
apply.
❑Windows/Doors
Generator Roof
Total Sq. Ft of Construction: 20, 9mo
Cost of Construction:
S Ft. of First Floor: _
Utilities:Sewer 0 Septic
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NameOCC%,Wic Oc[AN(�� C9,v0�.ria,up AlI�4.+rrtw, iLc.
Address:Lf(Wo N• 14w1,,41A
City:I'T, efeter- State:1zL
Zip Code: 3 4 f �rI Fax:
Phone No. 9 A I - "7 LP - 6 00S
E-Mail: D'u(_fa r 4 L'LLio'rr;mo(4Al4L• Co,M
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height: &
Name:_ -
Company: rLo0L, aF (%pAk fJ 4M I1OAt,A65
Address: f S'3/ 5/ 7 =' 4z1Z5'
City: .yp.10+9 A3!i:_ State:5L ,/
Zip Code: ' 33D(.0 Fax: '1 V--7 SV• 10�1 X
Phone No. �j5 .872• ��%g
E-Mail:
State or County License: (TE, f 32! 530
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
L0
SUPPLEMENTAL CONSTRU
LIEN LAW INFORMATION
MTi M
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
Zip: Phone: I 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.
K--1--7C2(�6a
_ Si nature of Owner/ Lessee/Agent
STATE OF FLORID
COUNTY OF . L. t_tc_( 4�
The forgo instrument was acknowledged fore me
this qay of ,A2�-�- en 20 tby
(Signature o)✓N ry Public- State of Florida )
Personally Known ` "AAAARrodbtSgabJdeanao
Type of Identification d . Ted Dodson
y m on
Commission No. 0'^ E)0m0 020
f''o;s
Revised 07/15/2014
STATE OF FLORIDA n
COUNTY OF
The forg�o,,ii�ng instrument was acknowledged before me
this Bi'day of _ IM, 20 _L6_ by
D-0� "
(Name of person acknowledging)
(Signatu otary Public- State of Florida )
u'0 rn.
Personally Known �0 fd'ucedl1enti i a i
Type ofldentification Pro t� eH NU a_r' cat0a
Commission No.
Ctb`33S
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS