HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: lln-a
By
St. Lucie Countv
Building Permit Application RECE-WED
Planning and Development Services t
Building and Code Regulation Division (XT 12 2017
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial ResiclentjSIER�ZAG
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 7400
Legal Description: t3an&
Property Tax ID #: 6,C101- (006 - 0o:30 - ocio -1 Lot No. 400,3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE,TAILED�DESCRIP�T-ION�.OFWORK�:
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1,04s,*CTION INFORMATION
Additional work to be ertormed under this permit -check all a—D DT%y: XWinclows/Doors
[1HVA Gas Tank E]Gas I . - Mutters
11 Electric Plumbing OSprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: $ c--Pq li Sewer 11
�? Utilities Septic Building Height:
CbNTRA-R-,
Name—
WaRe't )�a,%&
Name:
Address: �;-160 SVJ 1S6AuLnlL9_
Company:e5/�4e_,_�7ZP/,/
Address-14S_,05_10&721'
City: State: locf�/_
Zip Code: S2 418 Fax:
P h o n e N o. c2r__
city: Mirayrlw� State: FL
Zip Code: 3 5OQ!J Fax:
Phone No( 781
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: e466 05-C73 5-1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�SUIDPLEIVIE �00�Tk�*, !01� LIEN, LAW WAORMATION
DESIGNER/ENGI NEER: 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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in con4ict with any. applicable Home Owners Association rules, bylaws or an9covenants 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 vvorck�@ �ecor 1 g your Notice of Commencement.
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The fo;,g9iP9-mstrument was acknowledged before me
thl c-N day of V-0 � 20 Z_&
STATE OF FLORIDA
COUNTY OF
Th forgo' ' trument was acknowledged before me
h ayo _7�',
thi: f 20 /7b
y
(Name of person acknowledging I I I'Name of person acknowledging)
(Signature of Notary PubTfc- State of Florida I
Personally Known V/ OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
(Signature of Notary P lic- State of Florida
Personally Kno .... 70R Produced Identification
Type of Identification Produced
Commission No.
, MELISA ARMENTO
My COMMISSION# GG 056 41,�. AN 1 1 MYCOMMMIUNFUUMbuft
886
EXPIRES: December 28,2020
Revised 07/15/2014 EXPIRES: December 28,2020 �4
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