HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10%2.3 11-7 SCANNED Permit Number:
BY
St. Lucie County D
Building Permit Application ri,
7
Planning and Development Services OCT 20�1
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 PEp�ITTING
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X ResidentW Lucie C*11 FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Ili j rKOWS/
PROPOSED IMPROVEMENT LOCATION: xnyS
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Site Plan Name: tnf Koah T Block No.
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Setbacks Front Back: Right Side: Left Side:
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Gas Tan11
k ❑Gas Piping _Shutters Windows/Doors
El Plumbing ❑Sprinklers ❑Generator ❑Roof ❑ Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities: Sewer ❑ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR: ,
Name ('_ll a F - r Yia FCiYPSt
Name:lauld
I faPr[aGLE
Address:32(p ME- C0yY1e,10+ t�YiVC
Company:Jbt_'G'si. SsT>rofPssiC3nals
City:44)Y a. LlX')'e_ _ . State:EL
.Ini. �C
Zip Code: 549Qi3 Fax: jj� �}• .'
Phone No. '1 72— 2Zq-3O10
Address: '357C-;,SF_ :bit K.1 -H Wy
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City:. �7J�f't. �
Zip' Code:3i-14q_
Phone No. i7a-a (o
` • ' � j :i. = State: ��"
Fax:.•772 -2-9(0 _(3 (p I
' Qu SQ
E-mail: o bMme I C) b QCnt1' MSIt. nc�t
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
-ODYT
State or ounty License:
143(03
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 FLORIDAA/t STATE OF FLORIDA
COUNTY OF Iltomn I COUNTY OF Ma-YI r)
The forgoing instrument was acknowledge efore me The forgoing instrument was acknowledged before me
this day of �. 20 �L by this 23 day of, 20 �� by
G 4�� -k +Or>°s-�7 -Dau ipA W PraCAlt
(Name of person acknowledging ) (Name of person acknowledging)
4(Q Q� -Zj imh-V
(Signature of NbWry Public- State of Florida )
Personally Known OR Produced Identification a/
Type of Identification Produced IFL DL
Commission No.
Revised
My Comm. Expires Oct 20. 2019
Bonded through National Notary Assn.
f Q� ?J 1 dXAD. r
(Signature of Notl#y Public- to of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
KELLY WIDMAN
Commission N ,z �;c ,ga. Lary, Public - S(s&4l)Flortda
5. ` A :.; Commission # FF 929255
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