HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE i cu FOR APPLICATION TO BE ACCEPTED
Date:�SCANNED Permit Number: I - �'iT� By
N at. Lucie County
Building Permit Applicatio
Planning and Development Services APR 1 3 ZO)$
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 --
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRQP.OSE® INPR�O�UEMENI LOCATION:
Address: /067"
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Legal Description: jI,
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Property TaxlD#:' 4T-331-odo2-000 Lot No.,
Site Plan Name: kj - ,'PS 4 Z l; Y I& r S Block No.
Project Name: J X V to � S
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1_._.-1 1 C,n n--I,. _ D:.d..
AWILlonal worx Lo oe penorrnea unuer uns perouL- aw(A du ulal. apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
ur
Cost of Construction: $ _'geld .
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
0W N ER/LESSEE:
CONTRACTOR:
Name
Address: -Lq4, N �� o�ON p v
Company;,-
City: 1 ix7Spn1 AGr! State:
Zip Code: % Fax:
Phone No. `%r%`L ) �%
res`s:' ">`-'_S'" -'de an o)-
City: 1p/Skey B4O164 State:f--�,i/
Zip Code: 3gOi Y? Fax:
Phone No 37-%34L,?
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail N616, S� lr�a i 14h MA i . (GM
State or County License C IX 0,11 6
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SLJPPLEMQNT GONSTit
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LIEN LA
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DESIGNER/ENGINEER: _
Name: gro�z� �- ova QN
Not Applic le.`
.
MORTGAGE COMPANY: _ Not Applicable
Name.. .
Address: q 1 S C's e 0,044-
u2.
Address:
City: Stater
3 Zip: V53Q & Phone 752 — 7— 9PSK
City: State:
Zip: Phone:
FEE SIM L TITLE HOLDER-
Name: 0 '1^ uS4L2
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address: aw 91VA
Address:
City: o..� A
City:
Zip: �qO/S'! Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.,
Signature of Owner/ Lessee Contractor as Agent for Owner
, htracto License Holder
=TE
STATE OF FLORIDA
FLORIDA
COUNTY OF MAJ4,rN
COUNTY OF__ s'gj'.v
The fQr�going instru�ye t w acknowledge before me
The forgoing instrum n wai acknowledged before me
1
this 11_ day of /'i l 20)y by
this � day of 1 20JZ by
ac6v uS,�61,4Q
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(Name of person acknowledging)(Name
of person acknowledging
al )
(Sig of Notary Public- State orida)
(Signature of Notary Public- State of Florida )
Urv
D �'OR
PersKnown— OR Produced Identification
Personally Known Produced Identification
Type of Identification
ype of Identification
Produced •••••w
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oduced PFY PL,
° MICHAELRAAZ
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