HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APP CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED tf u
Date. `� ` qo m Permit Number: 11t —01,q 1
RECEIV'D APR 19 2017 SCANNED
BY
launamg rermfi Appucailon
St. Lucie Counf
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
PERMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line III
I PKOPOSEDIMPRUVEMENI LUCAIION: III
Address:
Legal Description:
Property Tax ID #: \� c�� Sc5'i — od�45 - MO -'�S- Lot No.
f
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
I DEIAILEL) DE5CRIP1I0N OF WORK: I. _ III
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CONSTRUCTION INFORMATION:
AaaitionaiworKtobenertormed un er t is perms — checkall app y:
nn❑HVAC GasTank In
❑Gas Piping _Shutters ❑Windows/Doors
l�Electric OPlumbing Sprinklers ❑Generator ❑Roof = Roof pitch
Total Sq. Ft of Construction: ScFt, of First Floor:
C>u
Cost of Construction: $ \� �� Utilities: Sewer El Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name }�
Name:ye��5`��cve'Nces
--�p�l`y
Address:._ LIn
Company:
City.\ �11 ���..�ct_State:_
Address,
Zip Coder: 4,, } 6 Fax:
City: i R� State:_
Phone No.i]�___IA — � i I 1
Zip Coden4'� \ Fax:
C�elftth_ e✓ i5ct r, �Y^
Phone - 1 \'�S \
Fill
Fill in fee simple Title Holder on next page ( If different
E-Mail: cbtrowv �1—�Co`f
State or County License: C_1QSCp1WWD
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLtMtNIALCONS IKUCIION LIEN LAW INFOKMAIION:
DESIGNER/ENGINEER, _ Not Applicable
Name: �� 4� 1 ' 0y-'C>,\'
MORTGAGE Ct(V FW: _ Not Applicable
Name: V \ }{(�
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HO R: _ Not Ap licable
Name:)o W r e% R�1 ��c0 1-9)I:' 0S
BONDING C
Name:
Not Applicable
AddrPessssi MI -`-A 4iye
Address:
City:
1— dr
City:
Zip: Phone:
Zip: Phone:
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
as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 car. l uc %-Q, COUNTY OF -4 -_ l.J e t It
The forgoing instrument was acknowledg cj before me The forgoing instrument was acknowledged before me
this%*% day ofA9y\ 20 1by this_N�Sdayof 0Q4C%\ ,20n_by
�n4 V ecr' Le,cc.t vn'arf,;S
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PubliZ-State of Florida ) (Signature of Notary P1dblic- State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification _
Type of Identification Produced rr%l_ Type of Identification Produced IL L
pEANNAMARIE GNENS ..ma�yy�
Commission NO. `%-* I- My1�§ta1JlISSION#GG 022023 COmmisslOn NO. ��4T^a�� DEANNj GIVENS
"' EXPIRES: December 16.2020 MY CDMMI§SIGN#GG 022023
:- _ ..: ___�_.r,.,, uowry PublicUnderc+dters( 1.1,. ._ono= EXPIRES: December 16,2020
Revised 07/15/2014
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