HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETES �,(t�App,J,LCATION TO BE ACCEPTED
Date: BY Permit Number: I ��
—W-0 St. LUciP. Cni int%
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 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ►FRS III
Address: Gci(d) ,—S. oemn lyi VC ( a n i t . le_nczPn fRIffw-h L 3149�
Legal Description: The miYC]f ckr TL ui71-1 =Qi
Property Tax ID #i: W502- -702- COO(o - GCl3- CJ Lot No.
Site Plan Name: - Th(= M i I'( Mn r (1(1 f)C`IC) Block No.
Project Name: RCC 1C cy-S R cnid n (I
Setbacks Front Back: Right Side: Left Side:
f3e11-bve -+ replace (5) S 1 idI n9 G 1QSS doors.
A Cus-Corner has exis-> lnq shu.Mct-S. *
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HVAC Gas Tank
unuerumpeonu—CneCKau apply:
❑Gas Piping Shutters
Q
_
Windows/Doors
Electric 0 Plumbing
Sprinklers Generator
0
Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
5 Ft. of First Floor: _
Uti lities:Sewer [--]Se—
ptic
City: not p i i l e State:
-Zip Code:-I17Q,? Fax: N I A
Phone No. (n31-Q��-?tQlt�
E-Mail: 5bY]c 1n I IGiY 77 �(:clrtm a 0 _ r rY-n
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Building Height:
Company:_ II1P['I1j PflDeM1(JMt$
Address: 3!5'7() SY Oj)(j f?. A%AI11
—r
City: State:LEL
Zip Code:__34Rg7 Fax: 772•ZSio-(}y�l
Phone No.-17L-7SG -OL{-59
E-Mail: n I rt c c rnz AS7 o rnn i 1. r nr
State or County License:
construction is $2500 or more, a RECORDED Notice of Commencement
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DESIGNER/ENGINEER.
_ Not Applicable
MORTGAGE COMPANY.
Not Applicable
Name:
Name:
_
Address:
Address:
City
State:
City:
State:
Zip: Phone:
Zip: Phone:
_
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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 vn;h your Home Owners As 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 pos the jobsite
before the first inspection. If you intend to obtain financing, con ith lende an orney fore
commencing work o recordin our Notice of Comm enceme .
Signatulreof Owner/Lessee/d6ntractor as Agentfor Owner Signatu Contra or/ n Hold
New., )&-k
STATE OFfkefi B# OF FLORIDq��
COUNTY OF 6ffaaJIL COUNTY OF 4 1 a_yl�Yl
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this: day of IQge 20 I_}by this _Zday of 201--f _by
(Name of person acknowledging) (Name of person acknowledging)
'(Signature of Notary Public fXe of.€lerfd3'j �& Wk�/
Personally Known OR Produced Identification K
Type of Identification Produced 4r ; L (n,%e_
Commission No. (7) � —S&j; 07 (sgWIS G FIGURTfO
NOTARY PUBLIC STATE O
nATnOE
(Signature
Florida )
Personally Knowh-' ' OR Produced Identification
Type of Identification Produced
No.
Notary Public - State of Florida
Revised 07/15/2014 QUALIFIED IN SUFtur.n �"�' 2019 %?f O My Comm. Expires Oct 20, 2019 ' II
IRESFEBRUARY23, °' BagedthrouphNauonalNotaryAssn.
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