HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: R • ��'�%. SCANNED Permit Number:
BY
St. Lucie County RECEIVED
Building Permit Application SEP 15 20V
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 Mm
;'.PROPOSED IIVIPROU,EIVIENT LOCATION"`.
Address:
Legal Description:
Property Tax lD#:I q SfJI 10i(q 2S-b Z Lot No.
Site Plan Name: Block No.
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CONSTRhUCTION f ORMATION `., reFr'�OdY].
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I?I1,11.'11A/!,f *!1 PI1P l,�TC Iln Gr4 o�mlt—� of -_f 4 �4 inn .r
�UHVAC U Gas Tank Gas Piping UShutters ❑ Windows/Doors
IJ Electric 0 Plumbing, / �v1 [:]Sprinklers U Generator Roof Roof pitch
Total Sq. Ft of Construction: l `1 aj S . Ft. of First Floor:
Cost of Construction: $ A0,D t�Utilities: _ Sewer U Septic Building Height:
CONTRACTOR
Name IJd
Name:
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Address: 2 U E Me a I euctt v�
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Company: NPo �O �S}YwQ (�✓�
City: Pi_/—itcic_ State: H-
Zip Code: 3 � Fax:
2
Phone No. -1-1 Z ^ Zq — 1 � 3 1
Add s: 119 W V S •
City:TCUM , aN f State: �—
Zip Code: 3 y O Fax: %%Z- ZZO—I &2-
Phone No. ' 1 L Z_ ZO 1 _ gqq
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
E-Mail: CiPrini Q �o12nn iPl IQ COv✓�
State or County License: CC•7C O 15 7 35
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN,LAW INFORMATION:. "
DESIGNER(ENGINEER: _
Name: w �bre
Not Applicable
P L=
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:In
a' t
Address:
City: Q t
Zip: -3 Phone,5161 —24:9-
State:
L_)4:D
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencing work or recording your Notice of Commencement.
Signat re of Owner/ Lessee/Contractor as Agent f`=
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLOR A
COUNTY OF
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COUNTY OF UCf 4`
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The f r ng instrum t wa ackno ledged befor
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The for oin ins
g' tr ent was acknowledged befor
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this day of 17by
a v o i
this day of rnrL� 20� by
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Name of pers�tr aking statement
Name of person making statementPersonally
Known OR Produced Identific
Personally Known ✓ OR Produced Identifica
7 `s= �
Type of Identification
Type of Identification
a N= $
Produced
Produced
N
fiinature
�
(Signature of Nota P blic- State of Florida)
V U
�A of Not VPublic-State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17