HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �Q acg,"tbumber: RA-0100
I St. Lucie Count rR E r, 177 1, V E
Building Permit Application
Planning and Development Services NOV 9 1; 2916
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residsetntial
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address: jobb I filaw-so L)r- jk-_n6-e_n i5eaz"
Legal Description: OCA-C4-) 0," (,�Itculkj - 150LA�oyl 0r)nP__
Property Tax ID r)o to �2_ - wo - p
Lot No.
Site Plan Name: Gno CL, 5+0 Cc,
Block No.
ProjectName: Flotpou&kv-1f,
Setbacks Front Back: (p �1). RightSide: Left Side:
9fArd9nD"-DE5C-RIPTION, V, k�
I q D
7
-AaaitionalWorKtoDenerrormea
7
under this permit - cneCK all apply: Windovrq,(Doors
0HVAC El Gas Tank EIE I - Shutters
OElectric Ej Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction: S, Ft of First Floor:
Cost of Construction: $ IO-IM � Utilities'. Sewer OSeptic Building Height:
�A
Name 14dTO 06_5f In o- 1,5oAree-a,
Name: 0-he-5UP eic-h (no n.OL,
Address:- (C) S�5-1 0Ck&!n DC
Company: StUnd F-enc-C, 1217W)POLn�j
City: �Iwntn �Bcailh State:
Zip Code: 1 41�_ 9 Fax:
Phone No. t0,3 0 - al .1" Lk
Address: PQ 1�" afn3Lp
city: I 4kAar+ — State..-E-1-
ZipCode: Fax: '7
Phone No. R'W— [1,51
E-Mail:
Fill in fee simple Title Holder an next page ( if different
from the Owner listed above) I
E-Mail: , QhRI(sixL�. ne-f
I State or County License: cWcl 7?
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State
Zip: Phone:
FEE SIMPLE TITLE HOLDER: L/ Not Applicable
Name:
Address:
City:
Zip: —
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
Applicable
St. Lucie Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in con4ict with any applicable Home Owners Association rules, bylaws or an9covenants 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
Signature of Owner/ Le5see/Agent
STATE OF FLORIDA i -
COUNTY OF I W--h ri
The forilgi . ng instruTent wasacknowledged before me
thls_a�!�dayof 20 JLP by
STATE OF FLORI A
COUNTYCIF NIV44)
The forgng Instrurvent was acknowledged before me
this— ayof A)6-e)fJWbW 20 &by
.:�ayvi_ 12 Je P -
I?( " -h a, 6-v"�
(Name of person acknowledging) (Name of person acknowledging
a � - �-. 6Ad' � - �'�
(Signature of Notary Public- State of Florida (Sign&ure of Notary Public- State of Florida
Personally Known OR Produced
Type of Identifica QPce
e
c
�n' MOMM
Commission No. -1 MY
Revised 07/15/2014
Personally Known V/ OR Produced Identification
Type of Identification Produced
IIFF185430 Commission No. 44�� DIAME&A BOND
or 28, 2018 i.1
(.�AUI_-) MY COMMISSION #FF1 85430
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