HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
G 12-2 1 l-7 SCANNED 6
BY Permit Number:
St. Lucie County
Building Permit Application
Planning and Development Services
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
I PROPOSED IMPROVEMENT LOCATION: III
LGAMM' ia904*09i/'M&/1�.11Ij1R!111 o�li�'�l��tii���at'I i I 1i
Property Tax ID #: li-ZQZ- 834-[np - on -'a Lot No.
Site Plan Name: f_�M w I nctt oo O D Block No.
Project Name:�,iYKeif'�I�.����.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
� emov e 0-nd v--place. (5:) s i n I •e hu n (
,1=Ixed window cLRd (I� sliding G ass eloo�I vv Jm
CONSTRUCTIONINFORMATION:
itiona wor to e e orme under t is permit- cnecK all In apply:
1:1HVAC Gas Tank E]Gas,Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers U Generator 11 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor:
Utilities:12SewerE]Septic Building Height:
OWNER/LESSEE:
CO.
Q .Oft
Name
e -
a"
Lopm
Or
Ad&Q'-.1 s- or 11_' ]rI UP_
ini-pl
company: `T-Ye CT10<
Pjro;iF 'SimaliS
City:'YISPYI...Pl'�I'•1',,i'Ii' State:FL_
Address':'�SZC�r$�S
�IX��, ��Wy
Zip code'.°31J95`-1
state: FL
Phone No.In� 3Q4 Z 5)
� ✓'
Zip Code;,�gq'` '_
Phone No. --7Z 28(o'C459
`Fax:-28tO-Ot F (0 I- -
E-Mail: P ,1 kPf 501(aln,mo 1 O.(rm
Fill in fee simple Title Holder on next page ( if different
E-Mail:
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
N
IAL _
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
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
commencing work or tecordingxour Notice of Commencemer&.� rn ��
as
FLORIDASTATE OF ���111 COUNTYOFSTATE OF ORI)
COUNTY OF I 1�C X_ k_R)
The forgoing instrument was acknowledged before me
this 22 day ofx . 20 1-7 by
_lwi-iA Lo—PM—CL-Q,
(Name of person acknowledging)
C
(Signature of Notad Public- State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/1
Notary Public - State of Florida
My Comm. Expires Oct 20, 2010
Contled through National Notary Assn.
The forgoing instrument was acknowledged before me
this7.2_dayof_'1C!Qft6XY1.,i]p1(.20 (% by
7)OLU %G l ot-Rci t
(Name of person acknowledging)
- QQOIJ'7 e 0I A A)
(Signature of Notbry Public- State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No.
Notary Public - State of Florida
Commission r cc 929759
1y Comm. Expires Oct 20. 2011
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