HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J]0J. 004A-
Date: SCANNED Permit Number:
BY
t. Lucie Counti,
Building Permit Application
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 )e Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow atthe end of line VJ ir)d
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Address: c1bCY3 S. OCeCo-) T)Y-ivc uni-t atal, jensen -L�ecjnh, 3%gs-7
Legal Description: en-)Prc,.c�s C%QnLdcw�)W),�ti,m tir)OC ao� 't
PropertyTaxlD#: Lot No.
Site Plan Name: -Thf- Block No.
Project Name: Ue
Setbacks Front Back: _ Right Side: Left Side:
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AdditionatworKtObe errormed under this permit--cFe-c-Fall aapply: M WIN TO
CHV, Gas Tank E]Gas Pipir [IShutters Q6nclows/Doors
11 Electric Plumbing OSprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer Septic Building Height:
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Name: -WiNiid
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Adclre�ss=���� Company: pffk:&<3brnfQ\
City: Jfmnseo R)cQ0,,h State: EL Address: T 506('_ -VAA�q
Zip Code: -94qEZ;J Fax: city: Z��A(Ar+ Stat'e:EL
Phone No. Zip Code: 1:_;1_49q_1 Fax: 2-7a-a%-0140
E-Mail: Phone No.
Fill in fee simple Title Holder on next page I if different E-Mail:
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from the Owner listed above) State or County License: (45t)�
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
MR
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
Not - Applicable
Address:
Address:
City: State:
Zip: Phone:
City:
Zip: _ Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
—NotApplicable
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.LucieCoun makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conlylict with any applicable Home Owners Association rules, bylaws or ang 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 Ien_deFeirsrraR-Gr�ey before
Owner
STATE OF FL
COUNTY OF
STATE OF FLOR'D)4&r
COUNTY OF 1 41,0
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this3 day of JAIILZ" 20 L7 by this day of J
r�,Q ua1:6;e .20 /7.by
0yX___ 6atlicl lwmo/e'
cknowledging) (Name of person acknowledging)
/kjc _�L � , 7-0crLm Q"Vu 61"
(Sign5ture of Notaa Public- State of Florida I (Signature c6Notary Public- ate of Florida I
�.AL-.d6Ah.a d . Identification V/�
Personal'— � . .....
A I—
Type of Identificatio od,
KFI IV WInMAN
Notary Public - State'of Florida
a at
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# Ff 97929255
(Seal)
Commission No.
Com9didi # FF 929255
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My Comm. Expires Oct 20, 2019
Revised 07/15/2014
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