HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI -.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 117i 17 11L_ suANNED Permit Number:
BY
i, _ 4, -nt. Lucie CountV OCT 2 8 2016
Building Permit Application
TING
Planning and Development Services L cie
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: —
Legal DescripiRoPG
Property Tax ID #: 13 01 • (D a - (),Pu/ - DQo Lot No.
Site Plan
Project Name:
Setbacks Front Back: — Right Side: Left Side:
HVAC Gas Tank
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Block No.
Piping ❑_Shutters ❑Windows/Doors
nklers []Generator g Roof Roof pitch
_ S Ft. of First Floor: _
UtilitiesIlsewer ElSeptic Building Height:
Name . Lucie C 1
Name: Donald (Leri-
Address:o9,300 )rCi,C3 Owe
.
Company:DW f`CCrP_al uY)
StYyiC(N _'JCj'LC.
City: fps'-L PI e rCt
ZipCode: Fax:
Phone No.
State:
Address: L)Y0 0 No '19-1" III-e . * 0 SE-
City: )orCx�_
Zip Code: 3.312-.L FaX`5L1Pyb
Phone No. I —Vl g_ 4g I c(
State: —
7T 1313
E-Mail:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: /i I i) e. -+
State or County License: r. rT r 1 S a o y z y
„ .o...a V un,aareceun ,»cauu Of more, 4 newnueu nonce or wmmentemem is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: ✓ Not Applicable
Name: Karrii 9(() rrd Name:
Address:3-)'I 4atatw -Ml Address:
City: PrlkWngm 5 6n Stater City: State:_
Zip: 3z`Iol Phone: 4o1-'l4o-S444 Zip: Phone: 11
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Applicable
BONDING COMPANY: ✓Not Applicable
Name:
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
r •1
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
k S
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIgqt/� ,p STATE OF FLORIDA
COUNTY OF 1�t•d� +Ct a COUNTY OF P,11 mitr ad-1
The forggoing instru enCC w s acknowledged ppefore me The forgoing Instrument was acknowledged before me
this IM day of Ci O f- 20 I ( by this L day of U C3o �Cr 20 11, by
9�twa&ci M-A.411iews 2bnaI&Late.34-
(Name of person acknowledging) (Name of person acknowledging)
( tgn ure of Notary Public -State of Fla da )
Personally Known ✓ OR Produced Identification
Type of ldentific ._
Commission
Revised 07/15/2014
IdQiaha l-i�Q.ths-
(Signature of Notary llc- State of Florida )
Personally Known `/ R Produced Identification
Type of Identification Produce{ KEISHA HOTALING
NOTARY PUBLIC
Commission No. 0' r—I ' hSU(SEW FLORIDA
_ Comm#FF021704
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