HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIOWTO BE ACCEPTED _ O ��
Date: Permit Number:
- SCANNED
4111111- BY
Building Permit Application 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_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
,PROPOSED IMPROVEMENT LOCATION: `
Address: I t ;h"c7 S U5 —
Legal Description: 'ZZ
Kum S Z_1 uccs 3`g HEN L. ZXO "1-t Vc, \3 LJ\
T. E.G ZZ P-'��w -moo c•
Property Tax ID#: '3LAZZ- 2\l- b0lD—bD0-b Lot No.
Site Plan Name: Block No.
Project Name: �oc S� �uL\E ��azp LLB
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
*"00 1-V0-c &? C Orr 12c,10.)V LLlJkA
CONSTRUCTION INFORMATION:
rtinnn ,.,nr in one nrmn nnnr f mnn...rt_r c�..� ,:r � inn ... `
L_IHVAC L.j Gas Tank UGas Piping
11 Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction: _-2-k 00 b
Cost of Construction:$ (vS,SUO�
Shutters ❑ Windows/Doors
Generator Roof = Roof pitch
S Ft. of First Floor: _
Utilities:T] Sewer []Septic
Building Height:
OWNER/LESSEEi
CONTRACTOR:
Name oc S cc L Q�® zo LLB.
Name: � L v,, C�'onN Zp C Z
Address:
Company: V�, P\uS ZQ L-\ v -\
`,`1
City: C�N oN State: `�
Zip Code: \ \ DD3 Fax:
Phone No,(A S L-1 - DZZ O $ Z Z
Address: 11 D 1 t> S L Z. \ \q OV
City: Stater
Zip Code: 33 \, —I Fax:
Phone N\S o. 3 OS - 0-1' $
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: � oy��� eQ\usLQup� c o �tiG
N
State or County License: C-.C_C.133 0`116Z
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
ENTAL CONSTRUCTION LIEN" LAW
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 with lender or an attorney before
commencing or recording our Notice of Commencement.
s
Signature o wrier/Less ontractor as Agent for Owner
Signature of Contra se Holder
STATE OF FLORIDA
a e_
STATE OF FLORIDA
�Qe
COUNTY OF 1w,1,6
COUNTY OF
The forgoing instrumM s acknowledged before me
The forgoing instru��ent was acknowledged before me
this /5q\day of120/%by
this_adayof �cbruoc4 20by
(Name of person acknowledging)
(Name of person acknowledging)
Notary Public- State '
(Signature of Notary Public- State of to ida )
(Signature of of Fldri a
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced IType
of Identification Produced �_DAeemoeoe�m r
a&µY:s DENIARMBIGUEZ
* ♦ IN COMMISSION 4 FF 156456
Commission No. 14SMbU0MML IlIFF15M,
Commission No. E!(�RONovember30,2018
EXPIRES: November30,2018
;,,WdO'r Bonded ThruBAetNobiySenka
BondedThruB et Nob Benker
Revised 07/15/2014
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