HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED bass
Date: SC BY ED Permit Number:
t _ s. :;; St. Lucie County RECEENE
0
Building Permit Application
OCT 12 2017
Planning and Development Services r', 'T'i':
Building and Code Regulation Division St. L_, c!r t .
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
PROPOSED IMPROVEMENT LOCATION
Address:
Legal Des
Property Tax IDN: 35aa -%0.?-a606--Doo-.Q Lot No.c3-2'5-/9
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTIOW NFORMATION`
itiona wor to enL- orme under tis permit - checK all appy:
❑HVAC LJ Gas Tank ❑Gas Piping Shutters l��t Windows/Doors
❑ Electric ❑ Plumbing []Sprinklers ❑ Generator LJ Roof ❑ Roof pitch
Total Sq. Ft of Construction: '//
Cost of Construction: $ Z-kl fz
SgI�Ft.� of First Floor: _
Utilities: LJSewer ❑Septic
Building Height:
OWNER/LESSEE
CONTRACT R:
Name Aoniintir
%agKandi¢r,
Name:
Address:_r -IiA S OC'IJOY] fir: R .9,96
City: '7wsan AEI ( State: -EL
Zip Code: 34ciS`7 Fax:
Phone No. (to3 i) Q14 -5o7 S
Company:ai VAfGTOI✓
Address62/5_,?S10&721
City: '7—zv'i715-C State: �L
Zip Code:33 418 Fax:
Phone No. 576/ - 33y -%/fib
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: e4dd 0 _q3 Sf
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
r-,
J
SUPPLEMENW, WNSTRUCTION LIEN' .'
INFORMATION: „.
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 Count
yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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. fyou intend to obtain financing, consult with lender or an attorney before
as
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
The forgoing instrum t was acknowledged Lpfore me The for iq instrument was acknowledged before me
thi : T day of 20 /16 this 7 9da of al , 20 % 7 6
-k V= ckaVd riuct-t-a-A �=Acr'ard n yyxv�m
(Name of person acknowledging ) (Name of person acknowledging )
'(.L.ul t '. -AXv t r
(Signature of Notary Public- State of Florida )
Personally Known �OR Produced Identification
Type of Identification Produced
Commission No.
(Seal)
1&�. gt �n��
(Signature of Notary Public -State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
3 ` • ' MY COMMISSION IIIGG 056886 :„ , MYCOMMISSION 8 GG 056886
Revised 07/15/2014 + pot EXPIRES: December2B, 2020 "•'• EXPIRES: December 28,2020
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