HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED {{-7 Date: n
SCANNED Permit Number: 1 1 0 -t CAS-1
BY
_ _ ._ . n�_ Q St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
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
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Property Tax ID #:►7/io7J- 7011--
Site Plan Name: , 6yll � / C ��1 Coco.
Project Name: "
Setbacks Front Back:
Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to e e orme under
OHVAC E] Gas Tank
t-Checkispermit
OGas Piping
a
apply:
Shutters
Windows/Doors
_
®Electric 0Plumbing
OSprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S
Ft. of First Floor:
Cost of Construction: $ /7 000. oo
UtilitiestSewer
Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name '
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Name:
^ _
Addresnns:.,S4(9,/2- eV_2 e� QA.,� ,
Company:
City: !?'"SI-LfA44.1 State
Zip Code: 3N95a Fax:
Phone No.
Address: 9
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IWu
City: �u
Zip Code: 341911
Phone No.%7-?-
State: ZAX
Fax: V(,I--?778
qG /- 777e
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:/•bi R e(@?pa 'de- ,a f e hiCa.L 0—oft
State or County License: AC /300-.5'd'ri 9
*94 G 8 05
It value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
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I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLPER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPgNN
Name:
:
_ Not Applicable
Address:
City:
Zip: Phone:
State:
BONDING CY:
Name:
_Not Applicable
Address:
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.)" intend to obtain financing, consult with lender cyan attorney before
as Agent for Owner
STATE OF FLORIDA I�
COUNTY OF V1 DH I
The forgoing instrument was acknowledged before me
thisgg@day of Sa.O—�_ 20 J'I'by
STATE OF FLORIDA %4
COUNTY OF —/-I o t-e ��
The forgoing instrument was acknowledged before me
this _�Wdayof!SFP7 M20 _" by
I V I 1 C1 V(�E�1 Y 10"c—
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi�- State of Florida )
Personally Known IZ ORProttuced Identification
Type of Identification Produced
Commission No. Y J �NOTARYP
STATE OF
Revised 07/15/2014
UC�LJ i A�
(Signature of Notary Public- State of Florida )
Personally Known �ZOR Produced Identification
l6y F e Identification Produced
dismission No. PT� 267f (Seal) DAVIDRAyN
i5 , NOTARY PUS
CarrrA I
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS