HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONv' ti
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: .SCANNED Permit Number: �?
t `.5 ,:.: BY
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 III
PROPOSED,IIVIFROVEMENT_LOCATION : , , _ _ -_4 n :. , ; . ; ,. •
Address:
Legal Des
Property Tax ID#: 359,2-60(a -0031-000-$ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTION INFORMATIONa . ,_ :
itiona wor torienertormea
11HVAC
under tispermit-check
Gas Tank ❑Gas Piping
all apply*
� Windows/Doors
_Shutters
11 Electric
OPlumbing []Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction:
$ �`f �� Utilities:li Sewer D Septic
Building Height:
OWNER/LESSEE
CONTRACT R
Name BAR-,Jh19 Riled JujUL/JOMdS ilftsl0Y
--r
Name:
Address: A2AO PrWS1DAIG Y/e.iAl
Company:aA'9e-, 7Z>1,1
Add ress:/66:5-9s 1k:2&7� —725v �,4o.Z7X/
City: �'`Uv°i%EC State:14=L
Zip Code: 92418 Fax:
Phone No. J`—&/ - 3S9--?//6
City: Mon hii um State:
Zip Code:- I-)S4S Fax:
Phone No. (-71.7 (0; 3 - r-i S 1 a.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Q�FA�Lro�/� /d�DC FG C'piv/
State or County License: �4dC 65-93 S/
It value of construction is yz51)o or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL LIEN LAIN INFORMATION;
CONSTRUCTION
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 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
STATE OF FLORIDA
COUNTY OF
The fwRaitte instrument was acknowledged before me
this_dayof i�aeE 20,/ fy
STATE OF FLORIDA
COUNTY OF
The forgoistrument was acknowledged before me
this 5 dayof 5' 20 ZZby
�N cw(\_Ch Vl Qf\
(Name of person acknowledging) (Name of person acknowledging)
AlV YhYil I,N�'
(Signature of Notary Public- State of Florida )
Personally Known VliOR Produced Identification
Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014 p r EXPIRES:
28,21)t0 Bo
"2(2
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
MELISA
EXPIRES: December 28, 2020
Bonded mni Notary Public Under nteis
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