HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�r 3
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: A)Uf1OC)alOnj'4S S.Ee�rpjtNulitber._ I7� �00M
03NNyOS fit. LucieBY Go
Ike
RECEIVED
Building Permit Application OCT 12 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
St. Lucie Coun Flll
2300 Virginia Avenue, Fort Pierce FL 34982 tyI-
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED'IIVMPROUEMENT,L®GATION.-
Address:
Legal Des
Property Tax ID#: 35aa - 603 - 000,, - 000 - % Lot No. l
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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ona wor to e erformecl un er t is permit c ec a apply*
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric 0 Plumbing Sprinklers 11 Generator 1:1 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ c:9 eA 70J
S Ft. of First Floor: _
Utilities:n Sewer E]Septic
Building Height:
OWN€R/LESSEE rh
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Name
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Name:
Address: SIOR S.W. $7 — (b)WtLSL
Company:i o,f ,fGTb/c1 �jeOT//�GSl�'•
Address:AsSS10&7W' %�Cf��CF,.loCTN
City: COOP9.1- Ug State: FL
Zip Code: 3332% Fax:
City: �"CJi°� 3'EL State:
PhoneNo. (9Sg1 4 3 Q - W 4.12
Zip Code:33 ` 18 Fax:
Phone No. 5-61— 'S&,/—'///b
E-Mail:
Fill in fee simple TitletHolder on next page (if different
E-Mail: cPtL.9���0�� .i C FG ,
State or County License: e446C 0593 Sf
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTIQN:LIEN LAW INFORMATION ,".`" III
Name:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 contlict 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
as
STATE OF FLORIDA
COUNTY OF
The fJ%9Y�g instrument was acknowledged be ore me
thisc/ day of Gr/�� 20 /%fy
STATE OF FLORIDA
COUNTY OF
The forgo instrument was acknowledged before me
this,!Cdayof -701VW .20 / /by
1Vic 601�chaylim ? �_moos1 aLaft:w
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida) (Signature of Notary Public -State of Florida )
Personally Known )I,/ OR Produced Identification Personally Known ✓/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) I Commission No. (Seal)
MY COMMISSION# GG 056886 �,; MY COMMISSION#GG056886
Revised07/15/2014 oyi EKPIRes:oecem6er26.2ozo1. ,o o?#SloDecemrl282oPNOg
;.,d ;t,.+ Sailed 7hiu Notary PLbko Undembis ,F,,?o• otary
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