HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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ODate: lam`' �� 6GANNED Permit Number:1�p
_ j - By Fat �iyD 1, 1 �-71I. h
o ® St. Lucie CnI,nty
Building Permit Application
Planning and Development Services PER:!,vT T i NG
Building and Code Regulation Division St. Lucie Counts, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _ell --I
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION;
Address: _2LI74 .S 0,CC4VJ br /70 9 6-We WJ -se� F)
Legal Description: L µtw�lq C� tNa�%o viL.r It# /7 a 9
Property Tax ID #: Z' ii0/^d!G 3-000
Lot No.
Site Plan Name:
Project Name: Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIOMgl, -WORK: -
CONSTRUCTION INFORMATION:
Additional work to be e orme un ert ispermit-c ec a appy:
❑HVAC flasTank ❑Gas
Piping _Shutters Windows/Doors
Electric
OPlumbing ❑Sprinklers ❑ Generator ❑Roof
Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ _ 13 0410 Utilities. ❑Septic Building Height:
OWNER/LESSEE: A. CONTRACTOR:
Name r14/9)ES v rRAw/ iw [ t ' -Name: j
,
Address: 72S /41y"0,14rn &)'r Company: APAr 72%;eftaN (-LC-
City: J' Z J,;4 g(fj state:N.T Address: /(i70U (t �t e / ,v/�er.r.
j.Phone
Zip Code: _l97L �7 Fax: ' City:.I!Qj&AA4 f. tw State: /'/
-
No. ^ —
Zip Code: 3 3 ef7 J Fax:
E-Mail: _ Phone No. J'Zc 1— !.G U - 33-0 L/
Fill in fee simple Title Holder on next page ( if different E-Mail: S'/ep4ew & 4 e-V v1;JVoibw+ c M.
from the Owner listed above '(
) State or County License: C GG / 5'2 /S7T
If value of construction is $250D or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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
commencing work or recording vour Notice of Commencement.
ED Y1 Z)iL A
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF S�,Lae Ile
The forgoing instrum nt was acknowledged before me
this )_ day of 67Q67 20 Mby
Personally Known _�OR Produced Identification
Type of Identificati
Commission
Revised
MY COM(SW)ON #FF170384
EXPIRES November 2, 2018
s
Sign Contractor/License Holder
STA LORIDA
COUNTY OF
The for oing instrument was acknowledged before me
this L�' day of i.' t' 20 1 ';� by
wt d l r s
(Name oifpftryon acknowledging )„
ignattfre of Not'ffy Public- Sthte of Florid
Personally Known � OR Produced
Type of Identifi , e uce
Commission Nol i • Sn1 MY COMMISSINdjfF170384
EXPIRES November 2, 2018
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INITIALS