HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a1 \25� n Permit -Number:
t'5�tr--',._ RECEIVED FEB 152017
SCANNED
Building Permit Application
Planning and Development Services St. Luce County
Building and Code Regulation Division
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 linepa Sly y J
PROPOSED IMPROVEMENT LOCATION;']
Address:
Legal Description: Ste• 1�tX�c� ���.��r L ')����`1�
'f7
Property Tax ID #: f:>Z \ e Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:g
CONSTRUCTION INFORMATION:
Additional work to be nertormed under tispermit-check all apply:
❑HVAC ❑
Gas Tank, Gas Piping _ Shutters dows/D�oorrs�
❑Electric 0 Plumbing ❑Sprinklers ❑ Generator _Roof I �/ PZI- Roof pitch
Total Sq. Ft of Construction: 2 S Ft. of First Floor:
Cost of Construction: $ 7�0� Utilities:cnSewer ❑Septic Building Height: ZD
.OWNER/LESSEE
CONTRACTOR:
Name=
Address: ? 1=3 'C- %"' e. e� 4} LI
' =
Company
�%,r-�L
City {� SL- Sta.hl
Address::/
City: Stater
Zip Code: - -----Fax:--
Phone No.
Zip Code: ` Fax:
E-Mail:
Phone No. `r7'7--`?
E-Mail: �i 7 kadtS Eo��� +4411 . C'�st
Fill in fee simple Title Holder on next page (if different
State or County License:0 t't A'z,-2 14A !2�
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
J
L
SUPPLEMENTAL CONSTRUCTIONLIEN LAW IN
Not
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
MORTGAGE COMPANY: //Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY:
Name: _
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Applicable
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 ell respects; perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications gre exempt from undergoing a,full mpcurrencq'reviev,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 ner/Le ee/Cont ctor as Agent for Owner Signature -of Contract�e older_
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sk•COUNTY OF Sk-. Ly c r-,
The for oing instru t was acknowledged before me The forgoing instrument was acknowledged before me
this, dayof t 20\by this �5 day of 20 by
\IVatc� �eC F \Aatt.tst`J
(Name of person acknowled ing) (Name of persTknowled ing )
(Signature of Notary Pu c- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced Ai V N I_
L1'�-�6�y l ,,+�y",_,�.,,' DEOMNAMARIE GNEN6
Commission No. DD 'R, 'Sedl'%COMMISSION#GG U221
?v_ Ems; F�(PIRES: Decembert6, 20
Revised 07/15/2014
(Signature of Notary P lic- State of Florida )
Personally Known ,••vwc°wh.OR Pr Ahldft�on
ofldentifica ''P d'edM #cc022023
�IRES: Dewmber16, 2020
....`"'0. Thm Notary I!A en%itom
t;o mission No..
1- —.
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