HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r�
Date: Permit Number: IU 0 d - 06 oo, J
Building Permit Application
Planning and Development Services SLHNNED
Building and Code Regulation Division BY
2300 VIrginia Avenue, Fort Pierce FL 34982 St, tuCie Coa
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial K Residential) t1tV
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: / qD 1 5. o C £A1i p 2xVE F JEN5
Legal Description: - 5 i5 E Arr,4c4SP
Property Tax ID#: 35-35-- 33.5- D O 00- 0 00-Lot No.
Site Plan Name:
Project Name:
Setbacks Fr
Back: Right Side: Left Side:
Block No.
IZF/rt0v.Z- 1,�c
IV,;-:VbJ /90c-6 /j£CO3?,7FC5;- 710 THE Fa/sTi� lciTR�/�
JUIL1UndI WUIR LU UV
❑HVAC
CIIUIIIICU UIIUCI LIIO F1CI1110.-1.11CGR dlI
Gas Tank ❑Gas Piping
dpply-
❑ Windows/Doors
_Shutters
12 Electric
Plumbing []Sprinklers
❑Generator
❑Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 1 61 9S5-, O 'o
S . Ft. of First Floor: _
Utilities:Sewer ❑Septic
City: Jbim E,2. State: FL
Zip Code: 33N5-6' Fax:
Phone No. `7 72 - 2l q - LI TN
E-Mail: 1)194` a 51 t-f' ive-i rP&TY(4&`IT C"
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
Name: K&IUMPI" EXXXOPI-Aq Vic.
Company:f'5)colCc7 LEC%�Z�L
Addresrs��s:.s60 NtJ E&7,6KyRTS6Z.. A
City: 14-7 57 Cuc-z-o State: iF7L-
Zip Code: .3y%86 Fax:777-3`/0 JY75-
Phone No. %72-3`/0- 7y7y
E-Mail: sw-ELL-yp (e GEeE(Co Com
State or County License: IiFC J S t7 0 3 `! /S
or more, a RECORDED Notice of Commencement is
Name:
Address:
City: State: _
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
MORTGAGE COMPANY: 7X Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY: A 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 ttorney before
commendria work or recordinif vour Notice of Commencement. V e
—Signature of Owner/
STATE OF FLORIDA / STATE OF FLORIDA �T Cc�C/
COUNTY OF ST c (JG(� COUNTY OF
The for oing instrument was acknowledged before me
this �T day of TcJ Lam- 20 j 6 by
of person
The forgoing instrument was acknowledged before me
this 13 day of 20 It_ by
,--:-7_
Personally Knowt R Produced Identification Personally Known
Type of IdentificaeTORIt W*RNE Type of Identificat
Commission No.MY COMM""# FF909394 Commission No. EXPIRES October 11, 2019
Revised 07/15/2014
of
Produced Identification
TORT } W#RNER
COMMISSION # FF909394
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS