HomeMy WebLinkAboutBUILDING PERMIT APPLICATION4
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All APPLICABLE INFO MUST BE BE C
Date:-1 `'�)\ 11 %$
FOR APPLICATION TO BE ACCEPTED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
Permit Number:1 <L C3
SCANNED
BY
St. Lucie County
Building Permit Application
PERMIT APPLICATION FOR: C 0
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
n
A l�
Commercial Residential.
Back: Right Side:
rs >4-1
_Mechanical _ Gas Tank _ Gas Piping
_Electric —Plumbing ow'09Sprinklers
ZZa.—
Total Sq. h of Construction:
Cost of Construction: $ DOO • U Utilitie
Left Side:
M
—Shutters
_ Generator
Sq. Ft. of First Floor: _
s: _Sewer _Septic
RscerveD
JUL 8I %-718
Pe mitLuc9fe epartment
my
Lot No.
Block No.
Windows/Doors
_ Roof Pitch
Building Height:
°OWNER/I±ESSEE:
CONTRACT®
Name
Name: l '4'= S e &IL
Addressss:/ WOO htt (
-C/Q-�'
Company -d l'Ltfr- :'Se-vvCLf G /
City: TY_ i-P+-r'Q State.-2>-
Zip Code: 3ggzlg Fax:?Z2-,5%_J-�6?bQ
Phone No. _'772- ,5]- c/B,;--�
Addressa:?oo t l.zt4n s/ S'
CitC--�s1�State:T
Zip Code: 7 7 30/ Fax:�73/n %S(� 9o3S1
Phone Nog77- TOJ - &/a%L /l?/(3-W.4 -5 72a
E-Mail: at.>n''_J lo) o h'0g jN o n fl e_cwt
Fill in fee simple Title Holder on next page ( if different
om-the Owner -listed -above)
E-Mail �Vvrk u-N e- It C'_
State or County License G'G G 4 � 10 ;I-'j
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
. UPPLEMENT LCO[VSTRUC�+TI0�iV.LEN LA }1VFOR
DESIGNER/ENGINEER: _ Not Applicable
Name:
AF}QN:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
ZIP: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
ZIP: Phone:
/1\111nI r1� / I.
Zip: Phone:
W ueecni a.viv a MA11.I UK AFtILM I: Application is hereby made to obtain a permit.to do the work and installation as indicated.
1 certify that no
work or installation has commenced prior to the issuance of a permit.
St.which is n c ntflic with any applicable HomeaOwners Asssong ciation rules, ylaws or and covenants that may restrictbor subject
it such
structure. Please consult with your Home Owners Association and review your deedforany 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
......_.._ Kr_..:__ _r"_____ _
Signature ot-OIner%Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF _l-ncji0tr�1 if
The forgoing instrument was acknowledged before me
this day of S3(. 4 201 �(Iby
(Name ofTerson acknowledging)
of Notary Public- $tate of Florida )
Persdnally Known " OR Produced Identification _
Type of Identification
Produced *r
} j ]IIMERCADO
...,
gK * * WCOMMISSIONIFF149788
Commission Na. EXPIR&Qust 11, 2018
yt �RUPPe BaWe4TNUB*IN*1ySenees
of
Holder
STATE OF F69RIDA t4ey1-h 1woliy10,
COUNTY OF New H om y P>/
The forgoing instrument was acknowledged before me
this A— day of 1Wu 20V9 by
of
State of
...
nm ,1
Personally Known OR Produced IdgotlI atl1F'_
Type of Identification � E
Produced_ NC �L IZ'I A1�_`L•�'`\oq+iv?sidN-E
°o OTq
Commission No. �� ? z f�Se o Ry
REVIEWS FRONT ZONING SUPERVISOR I PLANS I VEGETATION SEATUN
COUNTER REVIEW REVIEW REVIEW REVIEW I REVIEW
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