HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / v? I - Z SCANNED Permit Number:
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division r
2300 Virginia Avenue, Fort Pierce FL 34982 v/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
Ill 7'0 7- 0-1fJCIP
RE-
Residential
JUL 2 0 2017
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line II
PROPOSED IMPROVEMENT LOCATION:
0 .1 r
Property Tax ID #: Z O - Lot No.
Site Plan Name:
Project Name:
Setbacks Fri
Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK: II
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CONSTRUCTION INFORMATION:
U5101 VVU.l%LUU
HVAC
.IUI IIICU UIIUCI Ulli
_ Gas Tank ❑Gas
FCI II I II-I.IICI.R Oil 01.1ply.
Piping _ Shutters ❑
Windows/Doors
Electric
0 Plumbing
Sprinklers Generator 11
Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $%Orr7�
S Ft. of First Floor: _
Utilities: LJ Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name mgn-I.E'C' lsu) JAI
Name: 6491f-caYsIL
Address: 9 $b 1 %-C)CGdwf tQ _
Company: O 2NeaaD 0-All ., i, I L- C' R
City: -�c;hlSC-_l'4 {�,c? dC4 Stater-
Zip Code_"-id9�1 Fax:
Phone No. ")'T2 ?_Z9
Address: _I(o2 AIW `F�L�age.Y Grzovtc LvIl.T
City: cc,r- Sr-,- Z., )e State:_r-i
Zip Code: ZYa Fax: rl Co2,1 201
Phone No.2n-L 33Co{y Igb
E-Mail: Oroca !LC) 1" p
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: 08(r9 92]O Fp
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
.SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: 1L�Q_G6f tt.� (�t.LIGS
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:$C`� 17� L SwD2.S
q V
Address:
City: I=
Zip <r-) Phone:
State: 1:::'z
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 tgjpbtaimfoancing, consult with lender or an attorney bef%fte_- ';
STATE OF FLORIDA
COUNTY OF
The foir"ing instr me as acknowledge ore
this f dayof 20 b
(Name of person acknowledging )
(Signature of Vary Public- State of Florid
Personally Known OR �duced Idaij
tificati /
Type of Identification Produced
Commission No. 0 (Seal)
Revised 07/15/2014
STATE OF FLORIL! - ¢ COUNTYC
m
The forg ing instr nt was acknowledged before mall
P-..�:,.
this a' day of I 20 Z by
of person
(Signature of Nota ublic-State of Florida)
Personally Known 0ced du d Idenfificatio_
Type of Identification Produced
Commission No. (Seal)
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