HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1�lr�oxcZL/I-/ AL AdL
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �X6�\ J Permit Number: V 1 O - 31 i 3
RECEI': =D JAU 10 2017
SCANNED
Building Permit Application BY
St. Lucie Count\,
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
__4,�Residential
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
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Address: �� S �//'
Legal Description:
Property Tax ID #: S O Z — dG'rs —IJZ 0 — J Lot No.
Site Plan Name: Block No.
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Project Name: S l! r` • y A? Z B o X.G Z V 61
Setbacks Front Back: Right Side: Left Side:
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Bona wor o e orme under is permit- ec a app y:
❑HVAI Gas ❑Gas Piping Shutters ❑ Windows/Doors
Tank _
11 Electric 0 Plumbing []Sprinklers ❑ Generator ❑,�R/oof � Roof pitch
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Total Sq. Ft of Construction: //V S . Ft. of First Floor:
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2
Cost of Construction: $ � d O O UtilitiesSewer Septic Building Height: A Z1
Name: o o t- o
Name
Address:— 1 r,K� 4-
Company: si wa !e , c .r
City State: .r
Address: Z S-J(fP Ali- 3vli t
City: State:,LL
Zip Code: z-\r__ _ _ Fax:
Phone No. --T— EU /y0r- /_2,W
Zip Code: 1 r)L9 Fax:
E-Mail: i r,,—, iva S o , lA,�, a • c-o
Phone No. '? f Z 4 ? 7
Fill in fee simple Title Holder on next page (if different
E-Mail: %" o o. ra , 49 So-c 'r., Y.
, eo
state or Co_Lic n g:. CC / < 71
from the Owner listed above)
if value of construction Is $2500 or more, a RECORDED Notice of Commencement is requiredfi
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DESIGNER INEER: _
Not Applicable
MORTGAGE COMPANY:
of Applicable
Name:
Name:
Address: './ Gd a
Address:
City: a
Stater
City:
State:
Zip: �30Zr1 Phone:
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Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not A plicable
BONDING COMPANY:
of Applicable
Name: XZ Owe
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Name:
Address: .i k
Address:
City: a 00
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City:
Zip: Phone:
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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 witVf tder or an attorney before
A
STATE OF FL _ D/� / STATE OF FLORIDA
COUNTY OF�t/!r i %3C G r h_ COUNTY OFe
The forgoing instr ment was acknowledged efore me The forgoing instru ent was acknowledged before me
this,6_dayof Anombei 2o�by this �dayof �� — 20 /V' by
Commission No. v l/41--tPZ-- 4S a4- -
AW N. NFPEN
Revised07/15/2014_ I�� Bonded tuougA1st Sute
hard C� Johhs�n
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identifica ion Produced
No. j=lt:�19/6_2116cI
(Seal)
Commission # FF 21
Expires May 3, 2019
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