HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONV
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_O�hZ//Z Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982 ✓
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
SCANNED
BY
St. Lucie Count,
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 1111
I PROPOSED IMPROVEMENT LOCATION: III
Address:"��� TRorC�4L..T5%ES.o� SSG- II�
Legal Description:/o 3b pia r'A ,n SE ?° R 6-r G ?zs S ' c ow 6 zr sr ioy rN ,i pa brysz �/' S35 e W It
Site Plan Name: r:)L S l e- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: �7
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12'Y 1(P
I CONSTRUCTION INFORMATION: V III
LJHVAC I IGasTank "Gas Piping I (Shutters
11 Electric ElPlumbing Sprinklers Generator
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Total Sq. Ft of Construction: a16V S Ft of First Floor:
a�
Cost of Construction: $ �/�/g• Utilities: Sewer❑Septic
QWindows/Doors
aRoof = Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �rRoyic..EL_ D-0
Name: o.
uI S c-
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Address: ��/ i�iro�Ira/ TS�,�S C i/�U�
Company:
City: �o,� r'i p1 ekc &- State: /5L
Zip Code: 39 7' 9,2 Fax:
Phone No. ? 7 Z - 33: - - ) f) i (P
Address: // 7 Q_o &-&W
✓Aw r 64
City: rate -1-.,i t7iC-[-=
Zip Code: 3'11-i9
Phone No. 77a-�3z.-)95(,
State:-,(--6
Fax:
E-mail: S}l(r��ofgir�✓I�i+�/1�,�•50,4
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 3HS-F10 z;6(A
State or County License: G/3e,) 25'g5�3 Z
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: A
_ Not Applicable
A/,!YWZR542,&2�
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address Z4Ss ,ti,:;a/Yoee
4✓ryc
Address:
City: '0 as/O
Zip:.7.?;?2o Phone:
State:xa
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
ZNot Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 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 orrecordina vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA�_ ,��..Lu�iC l
COUNTY OF �Y�
The forgng instrul(��nt �'as acknowledged before me
this Mday of IYI� 20 2by
Personally Known ✓ OR Produced Identification
Type of Identification Produced
DAWNESE SMgA
ISSION 0 FFOMB
SS ature o for/License Holder
"� 9
W s Y
STAT OF F RIDA
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COUNTY
m�•�
The forgoing instru ent was acknowledged before me
< gw a
this oAday of�120 j7 by
m
of person
(Signature ofNotta,9 obli� to of Florida
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission
(Seal)
REVIEWS, '
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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CAS
COMPLETE
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