HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
SCANNED Permit Number: `Mot
BY
St. Lucie rhintt,
WEENNOMMUMMUNNNOW Building Permit Application RE C Eat
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Planning and Development Services
Building and Code Regulation Division MAY 1 ) 2017
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial_ Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line —`
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Address:lull \ S us J�� 1
Legal Description: 19, .3(o -40 ' aQt A GE' /'tl'I? o e N4l _, I a F O\N \ t,5 W 0 b
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Property Tax ID #:--OZJtJ — Lot No.
Site Plan Name:
Project Name: J�U\ , )I P,, fJ rQ KA
Setbacks Front Back: Right Side: Left Side:
I'16ETA)LEO DESCRIPTION,OF WORK..,ry
Block No.
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I"CONSTRUCTION=INFORMATIONe III
(-4t;(kLVAC LJ Gas Tank UGas Piping L j Shutters
Electric Plumbing []Sprinklers 11 Generator
Total Sq. Ft of Construction: q(q S Ft. of First Floor:
11 Cost of Construction: -ter J a :� �P D£lities:Sewer Septic
Windows/Doors
t� Roof = Roof pitch
Building Height:
DOWNER/LESSEE, _
CONTRACTOR: „
NameM@(X�
Address: 7JbUC) S D ,cml �D W2—
Name: goT
Company: O
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City:J OV-15v W �'i State: EL_
Zip Code: _ Fax:
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Address: (0(0� Si=_ 'S
City: e � Ld c- t
Code: _�.4,aSZ Fax:
Phone No. ZZ —
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: G( n; airli7o)V)��ng
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State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
`SUPPLEMENTAUCONSTRUCTION LIEN'LAW INFORMATION:
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DESIG R/ENGINEER: Not Applicable
Name: _ koc _ W Q-Ct* I-1I C_
MORTGAGE COMPANY:
Name:
_Not Applicable
Address: lq cSW 0&F #11
Address:
City: State:
Zip: Phone:, 1 9e
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
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
commencing work or recording vour Notice of Commencement.
omolder
Signature of Owner/Lesseen ract r 2igentfor Owner
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Signature of Contractor/License older
STATE OF FLORID/i� �� CI
COUNTY OF ��J)
STATE OF FLORID
COUNTY OF �V�£
The for oing instr t w s acknowledged,before me
this day ofZOby
The fo�oing instrument was acknowledge fore me
this��f1 day of by
/20�/�/
l r• [/
(Name a now dging)
( a son ackn wledg g )
(Sign Public- State of Florida)
State of Florida )
Personally Known OR Produced Identification
Personal) own OR P9q�,uced Id tification
r
Type of Identification Produced P I t" ,
Type of Identification Produced �♦'_6e� A
Commission No. TPq 7SSS(Seal)
Commission No. (Seal)
;y`t"•' JILL PERG
LINI
My MISSION # FF917855
Revised 07/15/2014 EXPIRES September fa, 2019
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REVIEWS
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SUPERVISOR
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VEGETATION
SEATURTLE
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COUNTER
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REVIEW
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REVIEW
REVIEW
REVIEW
DATE
COMPLETE
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INITIALS