HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� I
Date: SCANNED Permit Number: l -7l n — 00 /
M St. Lucie
CountyRECEIVE®
o; „�:
Building Permit Application KT 12 201
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie Coy�ty, 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
PROPOSED Im'P*bVEMENTIL-OCATION:
Address:
Legal Description:
Property Tax ID #: 351oZ - (no 3 - oo a7 - 000 -S Lot No<
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION IF WORK
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CID NSTRUCTION.INFORNIATION:
l UUILIUua1 VWUJ n LU U
❑H\
I1U1I IIOU UIIUCI UIIO PC11111L—LI ICLK dll
Tank ❑Gas Piping
❑pply.
Windows/Doors
_Gas
_Shutters
11 Electric
0
Plumbing []Sprinklers
Generator
D Roof
=
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities:cn Sewer D Septic
Building Height:
OWNER/LESSEE
CONTRACT R
Name Lctme-x. LeS I tlb
Name: 4z'. J 170*,e
Address: l23'17 EQt;jta. Lo.
Company:670 ie.Gill✓
Address:/42�isiS/O(pTN
City: �Ui'�TEC State:�L
Zip Code:33 1118 Fax:
Phone No.
City: Welk! State: FL
Zip Code: 33141 Fax:
Phone No.(3o5) 33- a o 6
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: elep n
State or County License: eBC 05-93 S/
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
r
SUPPLEMENTAL CONSTRUCTION LIEN LAW.INFQRMATIONi •,
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 Countyy 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
commencine worker ec�ordirle vour Notice of Commencement.
as
STATE OF FLORIDA.
COUNTY OF
The forw . instrument was acknowledged before me
this day of 20 ZZy
STATE OF FLORIDA
COUNTY OF
The fori�instrument was acknowledged before me
this J- day of 20 1-7 by
(Name of person acknowledging) (Name of person acknowledging)
&9 CAS , c4,wAeb&—
(Signature of Notary Pubbllii State of Florida )
Personally Known �/ OR Produced Identification
Type of Identification Produced
Commission No.
MELISA ARMENTO
Revised 07/15/201JJ"- Pf EXPIRES: December28,2020
'�.._,""+V BMW TIM Nogry Pubk Onder*ft
(Signature of Notary
-Public- State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
MY COMMISSION N GG 056886
EXPIRES: December 28, 2020
Banded Trw Notary Pt5a On*rwraers
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