HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /O• /a• /7 AlunoO along 'ASmit NueK%P1r=g 1% f 0- b-2 %2
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.: 09NNVOS BY
MORE St. Lucie COuRECC—IVE®
Building Permit Application OCT 1 2�yy
Planning and Development Services 2 Ir
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 %
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential J
PERMIT APPLICATION FOR To Select from dropbox click arrow at the end of line
PRQPbsED IM.PROUEWIENT.LOCATION '
Address:
Legal Des
Property Tax to #: 35 as - 60 N - 001'l - 00z) - Fr Lot Noc7/c' e
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK z ;III
J�LndDLIJR110tu_mut =�
Ta*J
HVAC _Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ElPlumbing Sprinklers Generator D Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ A�C2
S Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE c..
-,CONTRACT R:
Name S
C1
turn 1 itr
Name:
Address: *7420 S.000wn�r. C31(O
Company:67fff}�TP3l✓ BeOTH�GSlu(�.
Address :1665-95-10&7W7225�floLTf/
City: ►-6Y4IT�e-- —State:��
Zip Code:33 418 Fax:
Phone No. %7 - ✓'��`�- �//�7
City: J_U)SS-n AMC,h State: rL-
Zip Code: 34957 Fax:
Phone No. 5 I fo� H 9 1 - 32 70
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
E-Mail: eo'n
State or County License: edd OJ 93 S/
It value of construction is W50o or more, a RECORDED Notice of commencement is required.
SUPPLEMENTAL CONSTRUCTION
LIEN .LAW
INF,ORMATIQN;
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY. Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 wo ecor 1 our Notice of Commencement.
S
Signature of Owner/Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The fq"g instrument wa acknowledged b fore me
The four c g instrument was acknowledged before me
thins day of �/6[X2,0�l_Lb1y
by
`this`J/�1dnay�yof /��di✓r 1,20 y2�
L�Ard'y�l.k �,hQ�( lyl 1
(Name of person acknowledging)
b>k'b_;dA . _04 AWA ;bf=
(Name of person acknowledging)
h2.P1Z_J&' ,wf mrst�
(Signature of Notary Public -State of Florida )
(Signature of Notary Public -State of Florida )
y
Personally Known —Z OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification Produced
Type of Identification Produced '
Commission No. (Seal)
Commission No. (Seal)
MELISA ARMENTO
!"H 53 MELISA ARM
MY COMMISSION# GG 0568%
.e ,� MYCOMMISSION#GG056886
Revised 07/15/2014
s'; a- EXPIRES: December28,2(120
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0' EXPIRES:Detember28.2020
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