HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
SCANNED
BY
St. Lucie Countti
Permit Number:
Vpn
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
MAY 1g2017
PERSt. LucieMCc ING
uFL
Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
ROPOSED IMP
Address: al? S Dr J S-I
Legal Description:
Property Tax ID #: t�1� l0 ' Owl ' 'dam$ Lot No.
Site Plan Name:
Project Name: ci 1U6-( C-'curs) Cnur(1�n)sp Pic,
Setbacks Front Back: Right Side: Left Side:
Block No.
I DETAILED DESCRIPTION'OF WORK: III
CONSTRUCTION INFORMATION:
itiona wor to e e orme un ert ispermit-check all appy:
F71HVAC Gas Tank ❑Gas Piping _Shutters ❑ Windows/Doors
Electric OPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction: $ - L) o4 Utilities:Sewer D Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namesi Lucie Cou is
Name: es 6vsCL eci
Address:")V� S a C i
Company: P; 0 ran )rr-
City: �-1 P;PrC:R Stater
Zip Code:' 399SQ Fax:
Phone No.
Address: )559 SW 01 nVAQ
City: A I nuo(e'ra CLi e State: 5L
Zip Code: 3331 Q Fax: S66 - 6/S - 6$,7,�
Phone No. SCoL-a:29 - SSI 6
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: QKcrY)39333
If value of construction is 52500 or more, a RECORULU notice or r.ommencement is requires.
5
SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
-City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY,
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
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
commencine work or recordine vour Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent
far Owner
Signature of Contractor/License Holder
STATE OF FLORIDA `c
STATE OF FLORIDA
,,may' "',:o,
COUNTY OF g /l
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COUNTY OF )-,I , eCk
The forinstrument was acknowledged be
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The forgoing instrument was acknowledged before
e
this )a day of S 201
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this P day of 5 20 I? by
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o �2
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C SCUCCi
(Name of person acknowledging)
= _ >
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(Name of person acknowledging)
T d A
e
(Signature of Notary Public- State of Florida )
o_
(Signature of Notary Public- 9tate of Florida )
Personally Known OR Produced Identification.
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. (Seal)
Commission No. (Seal)
Revised 07/15/2014
REVIEWS
FRONT
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SUPERVISOR
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REVIEW
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DATE
COMPLETE
INITIALSUA