HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
All APPLICABLE INFO MUST BE COMPtiUreD FOR APPLICATION TO BE ACCEPTED (x}
Date: S , �Permit Number:U
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Building Permit Application Alit 1 7 •" ;
Planning and Development Services PPR:ai7Ti�d3
Building and Code Regulation Division St. Lucie t,ountI!, ;_,-
2300 Virginia Avenue, FortPierce FL 34982 P
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
RERMITAPPLICATION FOR:
PItO�POD I , $ ;OUP.
Address: m r Cl@L
Legal Description: l /-),e/Nl� iSf /7/i%/� r�,�7 rD
Pro ert> k I # LG ��dp ivJ d,L ZJ6 _ ZS6 -7 Lot No.
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Site Plan Name: Block No.
Project Name: 2IXJ6 e C
Setbacks Front Back: Right Side: Left Side:
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Tax
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itiona worK to ne pertormed unclerthis permit-checic all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric Plumbing —Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost ofConstruction: $ Utilities: _Sewer _Septic Building Height:
Name ,2 .rJCFSS d [�A G, .
Name:=` _ •- L/,/
Address-' d,5-y S Li( ejaLA f—
Company:i ' °'' 66
City:\yam.^ - Stater/
Addre,�s+s: c =M• ./=Sg I
City:/—%� N 1 ? �G't�� ' _ State:
Zip Code: J y 7 //S % Fax:
PhoneNo.? 72-" ZZ-g. Lj 6 Q D
Zip Code:,! u1%1 Z Fax: y/o.5 —/ 0 eo3
E-Mail:
Phone No 61)1
Fill in fee simple Title Holder on next page (if different
E-Mail 00 (f 0 r
State or County License S
IIfrom
the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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City: 6
Zip: Phone_t
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
r )/'�/�/C- Name:
r t y711 Address:
State* City: State:
a 3 zip: Phone:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City..
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that 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 andcovenantsthat may restrictorrpprohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
pI .
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 inspe n'if�ou intend to obtain financing, consult with lender o n orriey before
......•......n..+no,e,nr r rare rna7 ve'® Notice of Commencement.
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STATE OF FLORIDA.STATE OF FLORIDA
COUNTY OF COUNTY OF L i
The forggo�ing insitu� nt was acknowledggd before me The f foing instru ent w s acknowledged �Y4re me
this 2!"day of�l � 20/7 by this da of 11
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(Name of persofi acknowle ing) (Name of person acknowledging )
gnature o Notary Public -State of Florida) tyre of Notary ublic-St of Florida )
Personally Kni OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
broduced °OB-- SHERRIi
Produced MYCOMMISSI
is0 RES:M
Commission.No. y rr n p�FCFF N Commission No. o
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REVIEWS I CFRNT ZONINGOUONTER REVIEW S gIIEW R I REV EW YV EVIEWON I S EV EWLE I MREV EWVE