HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8 Permit Number: J EEL -
Building
SCANNED
-- -- - --= -
Permit Application BY
Planning and Development Services St. Lucie Countv
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X— Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION: III
Legal Description:
Property Tax ID #: Ld1ai y- 50/ <n// & - ODO
Site Plan
ProjectName:A4ate o
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
IG • . l r A�/JlIF'
/.
CONSTRUCTION INFORMATION:
Additional work to e nertormed under
OHVAC Gas Tank
tispermit-check
❑Gas Piping
all apply:
En
Windows/Doors
Electric 0 Plumbing
Sprinklers
_Shutters
Elenerator
EI Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $
Utilities:Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t✓
Name:
Address 6
Company: -
City: State:.
Zip Code: 510941& Fax:
Phone No.
Address: eq#3 16-,NQQ,
City: Stater
Zip Code: 0419V5 Fax:7%3-(Lb/-.)779
Phone No. �jZj- 446/-_D177
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: a) EF, d9 onii(e - 2.14,e, %h ca L . Cora
State or County License:,61 /alb-59`/,4
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLpER: X Not Applicable
Name: n5
Address:
City:
Zip:.
MORTG GE OMPANY: _Not Applicable
Name: A, , laanze d �w
Address: Sao d
City:aW State: L
Zip: _3�/4q -7 Phone: 97a- 9�-6636
BONDING COMPANY:_ rNot Applicable
Name: A I
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. If you iA�end to obtain financing, consult with lender or n attorney before
commencine work or recordine v6urlNotice of Commencement.
as Agent for Owner
STATE OF FLORIDA----, 1
COUNTY OF '-19 Q -i C1 .
The forgoing instru en w acknowledged b fore me
this ` day of 20 -My
Im ; "ate L Q, ; a,
(Name of person acknowledging )
C44A N L Vim"-'-'
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identifications Produced
DAVIDYM
Commission No. I' dio2,�¢� TAI R PUE
NOTARY FUE
a ATE OF FL
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF S� In�Cie.
The forgoing instru e t was acknowledged before me
this Lo day of 20 L by
(Nameme off person acknowledging ^)
(Signature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
JD PRUE OAVID RAYM
Commission No. Ff=1�t�4�S &Ic, „OTARYPUI
RID^ `�E�S^
TATE OF Fl
Explres 1/26/2019
Expires
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