HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y-�
Date: ��' "� SCANNED Permit Number: f I
BY
St. Lucie County R{ CERifE®
Building Permit Application MAR 16 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
L PROPOSED IMPROVEMENT LOCATION: I
Address:
Legal Description:
Property Tax ID #: �11 3-16- (goo/ 000 '-o Lot No.
Site Plan Name: Block No.
Project Name: Is L &nj:D �rILF�7�
Setbacks Front Back: Right Side: Left Side:
Con Crc f� A=Shsze t:9h 4 6CiVQe6n fl/ C/a�fs o/ (9rounct
/o/ , Zo/ , 30l , 4v/, j'0 � 8c)/ , 9a/, /00 `/fol/
120/ ?/O., S/o, 9/0, /o/o, ///o ar4y /z/o rs�Lc�niy�
'CONSTRUCTIONJNFO'RMATION
onaiworxtooe
er[ormea
Gas Tank
unueruaspernuL—uiecredn
E]GasPiping
eppiy.
❑�IWindows/Doors
HVAC
_Shutters
Electric
0 Plumbing
[]Sprinklers Sprinklers
Generator
I
Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2Q9 &C i
S Ft. of First Floor: _
Utilities:Sewer OSeptic
Building Height:
OW
NER/LESSEE;CONTRACTOR>'
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,
Name .TS t-"-rA , C��CZ&&!2aI AIiuAA
Name: L OnJI
CO L t/L
Address: /CA430 &!,t4 bM% �9-
Company: 12>LIA o-, GI E Cff;7w1
11
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87
City: :!ZeYt5 eA /%cre.-A State:
Zip Code: �34gJ 2 Fax:
Phone No. q2_- ZZ,7 /A? ;L
Address:%1/ !�A djzW4_ 5/
city: C lQ)
Zip Code:3ti-q�- Fax: ?';72-
Phone No. - 6-3 2 ..- hJ
State:_E(,
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E-Mail: I S GR�-S7' C-&-) f1oL Co%i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 64W, "i-% CSE
mn-1 L- d cotA
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
City:
Zip:,
State:
FEE SIMPLE TITLE HOLDER: VNot Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: I Not Applicable
Name:
Address:
City:
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
commencine work or recordine vour Notice of Commenrement_
Signatur w ee/Co
,almdor as Agent for Owner
STATE OF FLORIDA
COUNTYOF r . Lf )itel[.
The forgoing instrument w s acknowledged before me
this -16- day of rMg U, 20jt(-by
L
(Signature of Notary Public- State"of Florida )
Personally Known OR Produ ed Identification
Type of Identification Produced b L'
��1 ,_a� 9 � KAREN S. NI
COmm15510n NO. en '� Commission it FI
My Commission
Revised 07/15/2014
s
Signature ontracto �r e Ho
STATE OF FLORIDA
COUNTY OF
The forgoing instrument vqas acknowledged before me
this 6dayofWnCk ,20 f_Lby
(Name of person
(Signature of Notary Public- State of Florida )
Personally Known OR ProdµEed Identification
Type of Identification Produced F- L r).L
No. KAR($") NIELSEN
_- Commission 8 FF 115E37
My Commission Expires
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