HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: T�1 SCBY ED l Q
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Permit Number: I
t „ : St. Lucie County
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Building Permit Application
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Planning and Development Services
Building and Code RegulationDivlsion
Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772) 462-1578 Commercial Residential CDt1 p�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPQSEQ'IiVIPR01%EMENTLOCATION ;_ ' r
fi7-777777
Address: "5orp
Legal Description: T=slarNdi 11 ��ocri\ri urr\ i�\�'�W
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PropertyTaxlD#:
Lot No.
Site Plan Name: 6\nhlltc t1 Cc�r�oM\c���tvy-\ Block No.
Project Name:- i f-%�%-,�
Setbacks Front — Back: Right Side: Left Side:
ex+ rat 3 C � 5 k
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aCONSTRUCi'ION;wINFOFtMATION
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Adclitional worK to a orme un ert -checktspermn a appy:
OHVAC ❑Gas Piping ❑Windows/Doors
_Shutters
UElectric ® Plumbing Sprinklers Generator
Roof Roof pitch
Total Sq. Ft of Construction: 1 a1:1, S . Ft. of First Floor: �-
Cost of Construction: $ �1 Utilities:QSewer OSeptic Building Height:, W Cdo�i4
:OWNE11 R/LESSEE
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Name �O o mac. e a
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Name �
AddressR Soo S oc�a. 17c.vC Ll (1 \ t QD
Company :R�l\a�la FZmJ oo m� T
City�S4 r his �»c State: J\q
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Address:bt� t�l Wj ygY �Sd -
Zip Code: Fax:'l'i 2,
City:F�-111L :-kkcX� State:TAq
Phone No. -1 -1 i, cii q
Zip Code: Fax:'17(D 1
E-Mail:
Phone No. -'I-) 1 (oL(Q 1660
FlII in fee simple Title Holder on next page ( if different
E-Mail: \!D
MIlAem M&I-it�cpO, r�
State or County License: C G C 1` d5
from the Owner listed above)
If value of construction Is $2500 or more, a RECORDED Notice of Commencement Is required.
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: r
Address:
City: State: _
Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in confiictwith 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
TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
ants to your property. A Notice of Commencement must be recorded and posted on the jobsite
first inspection. If you intend to obtain financing, consult with lender or an attorney before
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA pp
COUNTY OF • (! U c x o COUNTY OF LQ f r t
The ,fprg )ing Instrument was acknowledged 'before me I The forgoingrinst ment was acknowledged before me
thi �dayof 20/-FJby this da of r-L 20 /� b
(Name or person acknowledging) (Name of person ac o ledging )
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(Signature of Notary Public- State of Florida) �' (Signature of Notary Public- State of Florida) %..
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Personally Known OR P duced Identification r/ Personally Known OR Pr�ooduced Identification I�— @ i; '- '
Type of Identification Produced Type of Identification Producedf G---J71 (.L) Ci r �J o a ° "
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�'t • (Seal) Commission Nd.)� .JIJ •,�rti (Seal) . - n
Commission No .0
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On a O T
® Monica Chambers
Revised 07/15/2014 �� oQ My Commlaeinn as e.��„ " m
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