HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETEDSEM& l(ATION TO BE ACCEPTED Got &
Date: BY Permit Number: I D —09
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St. Lucie County
BEGONE®
Building Permit Application OCT 12
Planning and Development Services 2017
Building and Code Regulation Division PE�fR1,TTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. LuVVddiE ( n�, FL
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
Address: 'M30 S. 0CQO_()-br. 2zy-
Legal Description: SUJ __')OiIQ,- Vr 1IQS eondoml aiww B tin aaa
Property Tax ID It: 35 oiri - bob- 0011 - 000 - 3 Lot Noo7.a=-'X b
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
0 T6t4 I
CONSTRUCTION INFORMATION:
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HVAC Gas Tank ❑Gas Piping
Electric 0 Plumbing []Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1 �� s
Shutters FxWindows/Doors
Generator 1:1Roof = Roof pitch
S Ft. of First Floor: _
Utilities:Cn Sewer EI Septic
Building Height:
OWNER/LESSEE
Name 1homD'sd- eRRi Walsb
CONTRACT R;,
Name:
Address: `11430 S, OC20.n r, aaa 13
Company:G//fRe_e_Ta/✓ BCOTs� Sl uG'.
Address:/6�i35-1(5&7,/ %�tC/dl£�o.LTH
City: � "Uv°'// TEOG State:
Zip Code:93 Y'7C.1 Fax:
Phone No. 1 -67 '
City: J-en3An (1G1 State: D-
Zip Code: 3 q qS 4� Fax:
Phone No. (3 `J K q4 - 66 5 9
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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State or County License: edd 05-93 S/
it value at construction is %zsuu or more, a RECORDED Notice at Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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: _Not
Name:
Applicable
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 to obtain financing, consult with lender or an attorney before
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
The folg�'tpg instrument was acknowledged b*Ore me The fob instrument was acknowledged before me
this J - day of VdAr� . 20 � y this S day of 1✓y�� 20 1-7 by
1 c�n�rd tit ZIcbacd Cmr ktan
(Name of person acknowledging) (Name of person acknowledging)
VO.i IJ6 , AAWJD(
(Signature of Notary` Public -State of Florida )
Personally Known `r POR Produced Identification
Type of Identification Produced
Commission No.
- Revised-07/-15/20
(Seal)
EXPIRES: December28,2020
Borded TAN Nobly Pubic Urdewmters
JPOIZJAL�A
(Signature of Notary
'Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
EXPIRES: December28,2020
Bonded TAN Notary Pubic UedeNmmrs
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