HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-'7
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(�/
Date: SCANNED Permit Number: , � n- F ^LA96
BY
St. Lucie County
Building Permit Application
Planning and Development Services R r �t4
Building and Code Regulation Division ED
2300 Virginia Avenue, Fort Pierce FL 34982 �p
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ResidXTa19 2
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the mdiai;i,,iun ,
rye FL
PROPOSED IMPROVEMENT LOCATION:_ ,
Address: 1g00\S.O�,�1r. (00A I
Legal Description: Sw& I IOX' V I I las Iona orYL i n i am E- a n& IOO 9,
Property Tax ID #: ,3$cl2 - (0e6 - 00.11 - 000 - S Lot No.b6o
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
11HVAC U Gas Tank ❑Gas Piping UShutters Windows/Doors
Electric 0Plumbing []Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: ' / ' 5 Ft. of First Floor:
Cost of Construction:$ /`/�Z%/ Utilities: �Sewer OSeptic Building Height:
OWNER/LESSLE
CONTRACT R: ;
Name M&r k C&r frie
- WUQMOXjnQ, LC
Name: 6 ifLp�GTo
Address: a s WI , llsid-99-
-br-
Company:afiflCG7D/V
Address:A;Segs 16*771 /dye G X10,CTfN
City: '7-Zo4/TEL State: 14=11—
Zip Code:33 47�46 Fax:
Phone No. 6/ - -///6
City: S4 P pmo n State: CT
Zip Code: 0f6i811-Ib31Fax:
Phone No. ( 8 60 Io 55— aaO
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: A,0z)
State or County License: C/46C 0 %73 S!
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION'LIEN LAW 1NFQRMATIONc
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:
Name:
_Not 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 1 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
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
The fo pg instrument was acknowledgedg f ;;e me The for instrument was acknowledged before me
this tJ - day of �. l/�� 20 ! Ky this? day of 7a1`4_9r' , 20 /%by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi¢-State of Florida )
Personally Known �// OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
(Seal)
MY COMMISSION # GG 056886
EXPIRES: December 28, 2020
Bonded Thm Notary Public Undervmlm
(Signature of Notary Public -State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No.
(Seal)
28,2020
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