HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: I j
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SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578 Commercial _ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR6P(?SEDIIVIRit01(EMENIL§OCION
Address: $n S D C2A4,N Ui r IC)1
Legal Description: 15101A AN (In P4 QL4nt % l'a�n �o m' n "i �n � Una-F 707
Property Tax ID #: S53,5- (oAcl. 405D 5 Lot No.
Site Plan Name: Block No.
Project Name: F] rl i
Setbacks Front Back: Right Side: Left Side:
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1ns>wtt Fauce*SI'i {a,�i I LSD 216hrS
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Haanionai worKio De errormea unaer iots permit- cnecK an
❑HVAC G sTank []Gas Piping
apply:
❑Windows/Doors
_Shutters
_ Electric L"J Plumbing
Sprinklers
E] Generator
Roof ❑ Roof pitch
Total Sq. Ft of Construction:
Sq.
Ft. of First Floor:
Cost of Construction: $ LAT, 3 cD
Utilities:
0 SevverEl Septic
Building Height:
OWNI (jt SS n = ` ` ,v a . „
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Name
Name: �lJ SFiY1 JC1�'iPrJ
Address ✓7 5. XC, `ZO
Company: 151A-n, K:-FG66
city::SM fir` C�Lc.4s State: _C�
Zip Code: 34Pi 51 Fax:
Phone No. 3,C6- Yi-
Address: I b8-) S S QC 4,-. 7r✓
City::ST) s n &4 c-h State:_j,
Zip Code: iz i _15, 7 Fax:
Phone No. -11.1- 0P37- 1 ri$
E-Mail: N I A
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
E-Mail: khi rU i kb 4.) CdM
State or County License: L' QG l ZSi 5-0 k
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLE` ENN'TAI�CQNST�UCi1QN`�LtEN`[A111%'I(�ORIiA7��Ti�01V'•
�:1'f�acers+rr•k..�n�lr:�s�ava��r?=�^�E�..�sst:?st�+>::r:.
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
AX
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR'AFF16VIT: 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 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./1
�t
.Signature of Owner/ Lessee/Contractor as Agent for Owner
t tt /License Holder
STATE OF FLORIDA
FLORIDA
WUNTYOF
COUNTY OF � LW�;e
S+ L-u a e_
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisfS_.dayof (er r 20 0by
this_3_dayof OG1bb4 20-1:) by
Name f person statement
Name of person making stat4m ent
Personally Known OR Produced Identification )o(
Personally Known Y OR Produced Identification
Type of Identification
Type of Identification
Produced 1>L1
Produced
(Signature o o ublic- Sta onda)
(Signature of Notary Pub a Fl%l "J'
MICHAELRAAZ
Commission No.MMISSIONlFF9Dg140CommissioNlFF28
a,201�9lfAN!{�n19
oft
�Y
'0
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17