HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.0
ALL APPLICABLE INFO MUST BE COMPLETED FOR "APPLICATION TO BE ACCEPTED r �
Date: c�(1 I In SCANNED Permit Number: I I
BY
St. Lucie Countv R- E 0- E- r kF[z
Building Permit Application JUL 2 0 201E
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL34982 St. Lucie County, FL
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: 5 a LV? Tvriupike 10ce. Ff• �. err �L ,3+/�r f/
Legal Description:
Property Tax ID #: 13a 1 110 1 5 o M Z t o o a O Lot No. O 4-o f-
Site Plan Name: Block No. 1 % Q
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF WORK: -`
- OvLe- T.L tvj L..,&Pev
_ f_X r C-q) ScYtlL5 C-D-1i1Y!�L�ell '" _
J, CONSTRUCTION' INFOR'jVIATION': III
HaamonaiworKtooe errormea unaertmspermit- cneCKall
E1HVP Gas Tank []Gas Piping
apply:
❑ Windows/Doors
_Shutters
11 l r! Electric Plumbing
❑Spri MLA
Generator
Roof
_
Total Sq. Ft of Construction: �
t. of First Floor:
�Z 5
Cost of Construction: $
®
d Utilities:
— Sewer []Septic
Building Height:
)OWN;E LESSEE
'CONTRACTOR: ..
Name` �?1,.,. .502 _ f-d.7�..22�
Name: �_(A_Zi()
Address: S(oo& Spd2'Lc SLi 1'L" tj�.
,(
Company: S. C-�� L+�s_ ��i/: < <-iLc
City: State: FL
Zip Code: �� Fax:
Phone No. 1 p-7-;r 2e; - 1 S 1 6
Addres • ! �� C UU9-1
City: /^S . -e-, State: rZ-
Zip Code: O/Pio Fax:
Phone No. [-_12- 3a/-2 �4
E-Mail:Joe-i?-e?I-O-Ff�COWCaSf. tJe-i
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: f3 KS J S I'-')
�F- O
State or County License: CGC V SO 60 .3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
`SUPPLEMENTAL;CONSTRUCTIOaU'LIEN LA1fU 10
MATION;
DESIGNER/ENGINEER.
Name:
_ Not Applicable
MORTGAGE COMPANY
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 vour Notice of Commencement.
_ Si n t'ure of Owner/ Lessee/Agent
STATE OF FLORIDA \ , ,GAL
COUNTY OF l�l
The forggoing instru,�[nr1ent was acknowledged before me
this 2vf day of J(, — 20 / by
(Name of person acknowledging )
Personally Known OR Produced Identification
Type of Identification Produced FL.ni1!
Commission No.
Revised
My Commission Expires
June 12, 2018
STATE OF FLORIDA _
COUNTYC !
The forging instrument was acknowledged before me
this6l dayof Jr-t y .20 %/i by
of person
Personally Known OR Produced Identification r/
Type of Identification Produced EL 0, L,
Commission No.
Commission H FF 115637
June 12. 2018
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