HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED F
Date: _ l
SCHNNEU Permit Number:
Count RE%WE D
St. Lucie
16 16
Building Permit Application lPE
Planning and Development Services
IN G
St. Lucie C un G FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR:
Address: 5101 AL 4 K)
Legal Description:
PropertyTaxlD#: L�'� l� - 00 - J Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
�ee-ar4t-[-T� o S'&F �ioQ�C
itiona work to be pertorme un er this permit-c ec a t at app y:
_Mechanical _ Gas Tank
_ Gas Piping _ Shutters _ Windows/Dodrs
Electric _ Plumbing
_ Sprinklers _ Generator _ Roof
_
Total Sq. Ft of Construction: -7 O 5
ff Sq. Ft. of First Floor:
Cost of Construction: $ 1500 - Dy
Utilities: —Sewer _Septic Building Height:
Name OceAN y02�5 Cp-�T
LNC Name: l2ob•=('+ 140tLg
Address: 6 / /✓. IlV f A-1 A
Company: 67-06r% TO ne rt 4 b t N • (/i C
City: ,i::!-- P f e f Gt: W
State: Address: / 6/ f -�/Pe fi V F
Zip Code: W q % 9 Fax:
City: State: f
Phone No.
Zip Code: �i 3 R I D Fax:
E-Mail:
Phone No $ G 3— 3 S l— G G S 9
Fill in fee simple Title Holder on next page ( if different E-Mail Ofro m 4TOO 1+0- -M o c .
from the Owner listed above)
State or County License C ;r i ) 3
P 5 L— 2to
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
al, 1:1110111
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Name:
Address:
State:
Address:
City: State:
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which is in conflict with any applicable
Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
structure.
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,
rooms and accessory uses to another non-residential use
accessory structures, swimming pools, fences, walls, signs, screen
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
A Notice of Commencement must be recorded and posted on the jobsite
improvements to your property.
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
cornmencing work or recorrdin our Notice of Commencement. .
G �!P_.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORID,��Q
COUNTY OF n _ COUNTY OF 441 l
�andc
The fo,,r��oing instrument was acknowledged before me The fof Ing inst u e t was acknowledOged before me
�uG� 20� by this day of .1W
this � day of
Kober � p N.or � �-t- P -�o�►�
(N of person acknowledging) (N a of person acknowledging)
r
(Signature of Notary Pu ic- State of Florida) ig ture of No a Public- State of Florida)
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of idTenti tcation - Gy INIF M. RUSS
{�LC�/Yl4Qi Produced �' MIs N#FF099941
Produced jl(40
EXPIRES: MAY 11, 2018
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ill FF 698035
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