HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p�
Date: P O' 1 Permit Number: �V 9
SGANNED
t Lim' ' JUN Q 12017
Building Armit aWlication
PER7AiTTING
Planning and Development Services St, Lucie County-, FL
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
I PROPOSED IMPROVEMENT LOCATION: III
Address: 73,06 .S.
Legal Description:
i0
Property Tax ID #: 662 Z 4c) 2.- M77—OVO —1 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit—check all apply:
EIHW Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers ElGenerator 0 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ I�t3
S Ft. of First Floor: _
Utilities:cn Sewer O Septic
Building Height: J00
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
p
Address: /�d0'$ OC h7.J A,. �`J"o3
Company: �'dYlS>t Z DN. LG G
City: State: F!
Zip Code:3JF9f7 Fax,.- - `—
Phone No.
Addressr-i 1G7DTI lf/. %eIA4,1". bi,
City: yDXA/fne State:)::
Zip Code: 33`7 %D Fax:
Phone No. 4ZI-6 6 o-3�0�
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: J7��/di /ftl/��� <f2vc�7�r✓,
State or Cou4y License: C6d1- Z 73_7 y
IIIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL;CONSTRUCTICjN'LIENrLA1N
s. .r„� �x
INFORIVIATIQN:'
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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
as Agent
STATE OF FLORIDA STATE OF FLORIDA L✓C
COUNTY OF ��. LVCi�_ COUNTY OF
The for oing instru ent was acknowledged before me
this I � day of 1 20 17 by
(Name of on a owled 'ng
( ' natu e o otaryu lic-State f Florida )
Personally Known
Type of Identificat
Commission
Revised 07/15/2014
OR Produced Identification
STEPHEN
MY G MMISSIMOWF170384
EXPIRES November 2. 2018
The forgoing instrument was acknowledged before me
this j1day of 20-17 by
(Name of p%Aollfacknowledging )
Type
Known '� OR Produced Identification
STEPHEN S
EXPIRES November 2. 2018
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