HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �y
Date: ' % % % Permit Number: I / D — JO i
ANNEU
SC
BY
St. Lucie Count' R EC E IV
Building Permit Application
Planning and Development Services FEB / 1 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line —Ill
Address:
Legal Description: ocitalrise cc-irY'iC3Y roil sr-1 opt (coln and Jr3diy
sv-are i n Comrnpr) f r2 t
Property Tax ID #: 4-51 k - 616 -CMti1--OW -,5 Lot No.
Site Plan
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Remove cane replace Lo i4oeizon,4al sliding
window w ti mpacb.
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Gas Tank
❑Gas Piping
_Shutters
Windows/Doors
0- Electric
Plumbing
Sprinklers
1:1 Generator 01
Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 2 I9m ,m
S Ft. of First Floor: _
Utilities,
Septic
City: Jrncen BQQ.(_il State: �.
Zip Code: ?i44'5% Fax: r-L ! A
Phone No. n 1 Q
E-Mail: - -- Y-1 I Gl
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction Is $2500 or more, a
Building Height:
Roof pitch
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Zip Code: qQFax:_P • r .
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required.
•�...�..�.y �..�...«... _ rvvt. Hppncaole MORTGAGE COMPANY: _ Not Applicable
Name: Name•
Address: q o i I r Address:
City I State: _�1•- City: State:
Zip: Phone:7 d to i Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permiL
St. Lucie Coun makes no representation that a 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 our paying twice for
improvements to your property. A Notice of Commencement must be recorded and osted on the )obsite
before the first inspection. If you intend to obtain financing c nsu th lender or n attomey before
STATE OF F--A------per-----•..o-..-
Ohl-Z) STATE OF
COUNTYOF _6 0zr b J 1COLINTYOF ORT A V � I n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9f day of 20 aby this -a day ofQGx," n 20 P by
A- ��hau ':a i o p-mo�P�
(Name of person acknowledging) (Name of person acknowledgingiAL,(
)
4 /.a— /�� — QPpo2Qn,�
(Signature of N tary Public- State of Florida) (Signature of N ary Public-Stateof Florida )
Personal Known X OR Produced ,g(ttification Personal) Known ✓ OR Produced Identification
Type of Identification Produced Q Type of Identification Produced
Commission No. (Seal) Commission No. (SW WIOMAN
rlca r,f Y LE-4 !-;"7797, •,o r uolg p Notary Public - State of Florida
:ra:f of Ohio ?' • Commission * FF 929255
vy Cpmml 6c i Eq.kew my omen. EXPItes Oct 20, 2019
Revised07/15/2014 '""t eardeattraiahwumxtw �aa
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