HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONt ALL APPLICABLE INFO MUST BE CG'.::: ETED FOR APPLICATION TO BE ACCEPTS.;
Date:
SCANNED
BY
St. Lucie County
Building Permit Ap
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
Permit Number: ' Wv Jn2as-
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
I PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description:
Property Tax ID #: �n �� Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
I .DETAILED DESCRIPTION OF WORK:III
3EUJau QW rV�.
I CONSTRUCTION INFORMATION: III
UfldI worn Lo Ue ellUrmeU UllUer U115 pef III R—UleLK dlI dpply:
HVAC Gas Tank Gas Piping _ Shutters
Electric Plumbing Sprinklers I� Generator
Total Sq. Ft of Construction:
Cost of Construction: $ ;'�c-7� alap
S Ft. of First Floor: _
Utilities.. 0Septic
QWindows/Doors
171 Roof = Roof pitch
Building Height:
•
• '• 3111
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i�! li..�4l�Ii11,'sGlil��� �
l
n eesimpe itle Holder on next page (if different
from the Owner listed above)
210 ON
61
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ENTALCONSTRU
LIEN LAW INFORMATION:
Name:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY: _Not Applicable
Name: _
Address:
Zip: Phone: I Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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
Wu 6(Q - Oirma. S
Signature of Owner/Lessee/Contractor as Vent for Owner Signature of Contractor/License older
STATE OF FLORID STATE OF FLORI
COUNTY OF atkkE COUNTY OF '1 11 SIP"
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _�_ day of 20 L(dby this day ofS ])2' , 20 _X,Q by
wdu mm I Lim C rtraliC n�
(Name of person acknowledge (Name of person acknowle g )
(Signature bfAcitary P c-State of Florida) (SignatuVeZONotaryP'� lic-State of Florida )
Personally Known � 1
OR Produced Identification Personally Known 1/OR Produced Identification
Type of Identification Produced Type of Identification Produced
Lao,•• HOLLY BUR �gmmiss nNo.� (Seal) _.
Commission No. .°, Notary HOLLY-
_ , Y Sta to a1 Florida •,,���� p�,,, HOLLY OMMOESS-_
Commission#
yComm. Expires Mar 18, 2019 �; ��s Notary Public - Bfate of Florlda
"�'••••, Bontletl through Na0aial Not Commission# FF 211412
Revised 07/15/2014 aryA>stt ' My Comm. Expires Mar 18, 2.,
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ALL APPLICA;RV INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNEU permit Number: r
BY
St. Lucie Count+ tr ° e��
Building Permit Application Ama45, ZU
Planning and Development Services -5t' luUate rC:0a3Nty.10L
Building and Code Regulation Division
2300 Virginia Avenue, Fort.Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residen al_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the nd of line
PROPOSED IMPROVEMENT LOCATI N:
Address:
Legal Description:
I
Property Tax ID #: W Lot No. iCQ
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right S• e: Left Side:
DETAILED DESCRIPTION OF WORK:
\' Q e�
o�
CONSTRUCTION:INFORMA ON:
un ert ispermit—c ec a ply:
❑Windows/Doors
AaClitional wo/ctlon:
0HVACk ❑Gas Piping _Shutters
❑Electricg ❑Sprinklers Generator ❑ Roof
Total Sq. Ft of S Ft. of First Floor:
❑Septic
Cost of Constr�� Utilities: Sewer Building Height:
OWNER/ SSEE:
CONTRACTOR:
Name ¢
Name
Addre • S
Company:
City: Te✓isevt 138" State:(
Address:
City: ' State^:
Zip Code: 3 t{q7 Fax:
Phone No. 772-- ci0i 337)
r
Zip Code: Fax:-ntX ,a9( 19�X]o
E-Mail: 0'�aL. ce ilA ►Nue- a/��sl , ✓1 eZ
�1
Phone No. Iel
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of commencement is required.
SUPP.,LEMENTALCONSTRUCTION LIEN IAW,INFOR.MATION';
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY:
Name:
Address:
City:
Zip:
Name: _
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
_Not Applicable
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
of
of
STATE OF FLORI A STATE OF FLORIgA v v
COUNTY OFF k I COUNTY OF r YY LA ��IF
The forgoing instr� m�ent wa acknowledge before me
this � day of ] 'a 2U[�by
of person
� 4 9 49'5.
Signat f Notary public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced fY
Commission No.
(Seal)
The forgoing instrument was acknowledged before me
this _ day of _, 20ta by
(Name of person acknowle mg J
40all Imasi
(SignatuiV Notary P ic- State of Florida )
Personally Known \J) OR Produced Identification
Type of Identification Produced
Commission No.T JQ ----(Seal) —
Puunp, """ ""no, 0 II
HGLLYBURGESS "Yw° +.
Revised 07/15/2014 •g ,t , NOWy 0:WeilFlorida
b Notary Public •Slate of Florida '. ` •= coaftim •ii211412
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DATE
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INITIALS