HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICA E INFP MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: r /9 /4 Permit Number: IQt.1^ -00
SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _ cX
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: LegaIDescription:JA�. Vh pp lltli
� (L(CyG —Z L28,52?f1G�
C2 93s-/781 /383-e23Z3
Property Tax ID#3d7c 5 70-5/ DO/ 006 3 // /� Lot No.
, Site Plan Name: JaJA O_A Ui ea J/IZrttOa Y7oJ P/z Block No.
Project Name: ,Qa.'LjQ� �t� �HyA gcvft.or Ptvrw�p
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: I
;4
CONSTRUCTION INFORMATION: III
L—jHVAC L==lGas Tank UGasPiping LJShutters
aElectric Plumbing Sprinklers Generator
Total Sq. Ft of Construction: S Ft. of First Floor: _
Cost of Construction: $ /-�Oo0 Utilities.. Sewer DSeptic
Windows/Doors
Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
tS_Lid
Name:
IaA
Address:
Company:
City: State: -4t.
Zip Code: 3Sl959 Fax:'M2-31/0.05,.4
Phone No.7,9v2 - le89
Address: $ ,z
j
City: A Aa-
Zip Code:3,/ 9J/5 Fax:
Phone No. 99Z- y(o /- a17177
State:_,zg
19.2-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Mike & jQ17 e - ¢ ftLcAi Ca L.C'/A
State or County License: EC
G 6/H
it value of construciian is>ebuu or more, a ittcoRDFU Notice of commencement is required.
I SUPPLEMENTAL CONSTRUCTION, LIEN LAW INFORMATION: III
DESIGNER/ENGINEER: Not Applicable
Name: „}
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COIV(1� NY: _ Not Applicable
Name: N I
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
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
commencine work or recordine vour Notice of CommpnrpmPnt I
—Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _by
STATE OF FLORIDA
COUNTY OF S`r Lx.c <.
The forgoing instrument was acknowledged before me
thisNc( day of A, o�\ .20 k(o by
1 tAc � Pam. &_"
(Name of person acknowledging) (Name of person acknowledging
(Signature of Notary Public- State of Florida )
Personally Known _
Type of Identification
Commission No.
Revised 07/15/2014
OR Produced Identification
(Seal)
(Signzi re of Notary Public- State of Florida )
Personally Known OR Produced IdentifQn
Type of Identification Produced . �Ft� Fg1Gyg�
. 5 24—
Commission No. °peryst'110
* EXp1FlE(i;�
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