HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: 1�lpYil�
BY
c ° '`� St. Lucie County .- necp
Building Permit Application NOV ����
Planning and Development Services 2 2Ql?
Building and Code Regulation Division PER.f
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie C , t N
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential °u';Lk
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I,PROPOSED.IMPROVEIVIENT LOCATION=
Address: C%r .Tc> S. Cep-?t+J a /q0r .� t�.us2T/�aef l FJ.
Legal Description: 'LS 1tMJC0i A-• T
PropertyTaxlDR:_ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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I.C(;�kST.RU9-,-IONINFORMAT!O,N:.,-,--
nnMona wor to e e orme un ert ispermit-Checka apply:
LJHVAC �GasTank []Gas Piping _Shutters windows/Doors
Electric 0 Plumbing Sprinklers Generator 0 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:$ 4 dvv
S Ft. of First Floor:
Utilities:Sewer ElSeptic Building Height:_
OWNER/LESSE,E _. z
_.
CONTRACTOR u
Name 0lstrIN G\ ber
Name: a I(*,j 014; ILS
Address: TM S. OC&hNlr /aair
Company: AoA- (Q ri5+?V67'A-1
City: T n)SES.1 -7bp #,r t-F Stater
Zip Code: i" 1`7 Fax:
Phone No. —
Address: (67400 W. e-kP—L4GVk-.'tli
city: LOY.AFk*cl�ee- State: FI
Zip Code: S g 470 Fax:
Phone No. Si. t— (iL O;ToyL
E-Mail: _
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Ao&Co VS+R VC( c J(IC L8! JWA.'(. f-/owt
State or County License: G I? t Q (f7T
C
it value of construction is SZSnO or more, a RECORDED Notice of Commencement is required.
Sl1PPLEMENTAL CQNSTRUCFIONLIEN LAV1/ INFO_R(VIATiON
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State: _
Zip: Phone:
City:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced priorto the issuance of a permit.
St. Lucie County makes no representation that is granting 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.
Inconsideration 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 FLORIDA
COUNTY OF 4I E+•F'.VGie
The forgoing instrument was acknowledged before me
this 11 dayof N.u. 20LI-by
Known OR
STEPHEN S BELTON
Ygj, e01 MISSION #FF%94
EXPIRES November 2. 2018
OFvniv..( -4. L.,c,e
The forgoing instrument was acknowledged before me
this 1S' day of NOV- 20 17 by
3onf tlAM
(Name of erson acknowledgin
(sib0haturie of Notary lic-State of Florida)
Type of
Known OR Produced Identification
STEPHEN S BE�Egp
MY COMMISSION #FF170384
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