HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: , -\ a 11 Permit Number:
RECEI``D JUL 21 2017
Building Permit Application SC $Y ED
Planning and Development Services St. Lucie County
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 III IJP,ROPOSED.IMP.ROVEME[4T°LOCATION..,," „ *'-
Address:
Legal Description:
Property Tax ID #: /46F6 2 — 80 2 On lie — O(Dd —0 Lot No.
Site Plan Name: //1I Block No.
Project Name: R—rz_a/m� S ///
Setbacks Front Back: Right Side: Left Side:
DETAILED;DESCRJ1PT10N AF WORK 4,
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6 )o,amd 710 -
ONSTRUCTION INFORMATION't+
1]HVAC Li Gas Tank
Electric 0 Plumbing
Piping Shutters I❑ Windows/Doors
nkiers L �I Generator Roof Roof pitch
Total Sq. Ft of Construction: /ru�. n-a S Ft. of First Floor: _
Cost of Construction: $ lW % Utilities: Sewer Septic
Building Height:
OUVIVER/LESSEE
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;CONTRACTOR`
Name /
e- Leon QgWd
Name: l: Li E TO
C)/Jl
Address: C) C
Company: aLat 6041-
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City: 1 Pm_, 56W &Q o�i
Zip CadeFax:
Phone No.
State:
Address: �% —5 �= S� /COI! 49inE S%
City: S7— State: —Et -
Zip Code: 3L. 4!_ Fax: ?;�J_'ZA
Phone No.��/�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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Name: NA::W9_a�s rAt —n1cl
Address:2/�/ SC ��UE
City: State:
Zip: Phone: � �7 28 �:S S
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conl"lict 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
Signature of Owne ess n or as Agent for Owner
STATE OF COUNTYOFORR , Luc.t�
The forgoing instrument was acknowledge rLbefore me
this ,N day of Z \i \ t 20 II''_by
s
Signature of ntra older
STATE OF FL pA
COUNTY O 4h • Cue\
The forgoing instrument was acknowledged before me
this A,\ day of 20 _Q_ by
tQ .Y6 t1 4It
(Name of person acknowledging) (Name of person acknowledging)
Personally Known ro ur �{jSygtif64 S
Type of Identificatio �6d t �GIDN# GG 022023
EXPIRES: December 16. 2020 It
Commission No.
ondedTh Public UnderMilers
:,iP '�
Revised 07/15/2014
(Signature of Notary
Personally Known _
Type of Identification
Commission No. 0Ks416 i
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