HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 29 Permit Number:
v SCANNED
BY
St. Lucie Countv
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 ResiderfWA1903i
PERMIT APPLIC9ATIO aFOR: Soo 0.41144
Address:
Leal De,
0
Property Tax ID #: S'�S- � O�
Site Plan Name: ooe
Project Name: SD/i
Setbacks Front Back:
Right Side
MR 0
Left Side:
3 � oJe
p/�
= i
Huaionai work to ue perrormeu unuer inisperma- cnecK au cna_c appry::
:Mechanical XGasTankGasPiping " _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of ConWdction:
Cost of Construction: $ 241—V o
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Lot No.
Block No.
_�' Windows/Doors
Roof
Building Height:
/6®
QWNEESS�E:CONaRACT®R:
Name ;TB,4 -rj i lrS U-Z
Name:
Seedre- 0As Sr✓i S -$f Sef{e
Addresssq:: %��0 G,
Company:
eui-e .4r StdiC�S
City: TvsrJl State:%-
Zip Code: 33 i172 Fax:
Phone No.
Address:
S • �tL� S �°
City:
Zip Code:
Phone No
GlS" State:
33 Fax:
3 93 ' -Z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 1C4,4 egA_T 6rlz 4,4k
State or County License :5441te — 3231TZ�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON?sm- $ ION LIEN
INFORMATION:
DESIGN ER/ENGINI EER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: .11,11<
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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
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
rnmmpnrino wnrk nr rprnrdinp vnur Notice of Commencement.
AWIA
Signat r Lessee/Contractor as Age '#,
Signature ontractor/License Hol er
STATE OF FLORID -
STATE OF FLORIDA
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COUNTY C X`
COUNTY OF
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The for oing in ent wa acknowledge befm
this day o 201 f by P �g
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The f ing in u����'as acknowledgef�,bef
thisday o VZ 2076 by Q S
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(1
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(Name of person cknowledging)
(Name of person Kcknowledging )
(Signature of Not Public- State of Florida U.
(ignature of ry Public- State of Moricla )
Personall wn OR Produced Identification
Persona nown OR Produced Identification
Type of Iclenti i ti n
i //�
Type of Ide •f tion
Produced
Produced .X�
(�
Commission Zo (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014