HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONh
ALL APPLICABLE INFO MUS II E--COMPLETED
'F' R AP LI TION TO-B&ACCEPTED
Date: �Di�l / J J2 Permit Number:CL
SCANN€13
BY
• St. Lucie Cpunty,
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
- See . 3 Q,1ciey- Z U A-tl
C car ano — t4i9 )
Property Tax ID#: 14511 - SOaJsoil J -000• 14511 -IDIDIM-011 .i"No. Ae((
Site Plan Name: Block No. U
Project Name:yell", 3 I VAC'
Setbacks Front Back: Right Side: Left Side:
t'?er,-,�T1e c t`�eptae� A PocA t d(1� 4 erg
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CONSTf2l1CT10N IIVFORtyIATtON
Add
rtiona wor to e e orme under tispermit-c ec a apply:
❑HVAC 11GasTank []Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑Plumbing ❑Sprinklers ❑Generator ❑Roof
Total Sq. Ft of Construction:,, II
Cost of Construction: $ �` t i �%` , o0
S Ft. of First Floor: _
Utilities: Sewer ❑ Septic
Building Height:
. QWNER/LESSEE,'" • =�• , � "
- CONTRACTOR;E,
Name
Name: ntP-A
La-JL'ofaf1CC
Address: S0- 0 S •
QQ-e-,en
company: L oieLS
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City: Se-nc
Zip Code: GOFax:
Phone No.
State: R,.
rea k-2
233.3^
Address:A``S S<
S-
City: \5�+ State: t(
Zip Code: "A-1 Fax: rlr)a• a� •25CO'
Phone No.(-I()a• a123 • AS?S
^'�Z
E-Mail: C (%T ttr cam' ✓ ~l
Fill in fee simple Title Holder on next page (if different
from the Owner listed above) 9r9-
E-Mail e(i � "+—s @
ieks Fenn-e - Cdr'\-
State or County License:
c�Lpa�Qa,
If value of construction is $25001or more, a RECORDED Notice of Commencement is required.
St1PPLEMENTALCONSTRUCTION'LIENIAVCtNFORN'IATIONF�� �^��� ��` `�'��`7 t�'��`
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone:
Zip: 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 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 Your Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
S
Si nature of Contf4ctorftitense Holder
STATE OF FLORIDA STATE OF FLORIDA _
COUNTY OF 5f Luc,e I COUNTY OF DA0LLt.v�
The forgoing instrument was acknowledged before me
this QA day of Arm t\ 20 Eby
1 Le-946L.k
(Name of person acknowledging)
(Signature of Notary Public -State of Florida )
The forgoing instru ent was acknowledged ' _before me
this S day of, 20 � by
Lz.n i >) LCiLW� p Q .
(Name of person acknowledging)
of Notary PkAlic- State of
Personally Known OR Produced Identification ✓ Personally Known J.�_011 Produced Identification
Type of IdentifcatType of Identification Produced
,¢•�puy, MARK RONKKO
.N ww,
Commission No. dip o NotuyPuE� �f(alea Florida Commi ioR,'N ;••, e
X.g Commission K FF 932620 „o� NNOIG-C. REYNOLUS
%7 ;¢ My Comm. Expires Nov 1, 2019 =, . Notary Public -State of Florida
Revised 0711514- as as as
,,oF n„F Commission 8 FF 151118
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