HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. SCANNED Permit Number:
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial. Residential
PERMIT APPLICATION FOR: '
e, _
To Select from dropbox click arrow at the end of line�
PROPOSED IMPROVEMENT LOCATION:
Address:' 4/735 J2,\V,l k2 � ...'.. —r T. P ercQ �L 34181
Legal Description:!
Property Tax ID #: Lot No.
Site Plan Name:' Block No.
Project Name:;
Setbacks Front. Back:' *Right Side:' Left Side:;
DETAILED DESCRIPTION OF WORK:III
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CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit-check all apply:
❑HVAC GasTank ❑Gas Piping _Shutters ❑ Windows/Doors
O'e"ctric El Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: 5 Ft. of First Floor: i
Cost of Construction: $ g-0; • �'� — _ utilities.. Sewer Septic Building Height:'
OWNER/LESSEE:,
CONTRACTOR:
NameDewe rio 6aMA4
Name: 1 *lit e2
Address'6cl7, N\J ArA zr AVE
Company: MUlJIC," ..l J 'UedCKJ.J
Address::15Z 55 Uesiwood Ctcc.le, .<- ,'
City:?o4 S,,%a - Uyct-e- State:jFLi
Zip Code: . � — k3 Fax:'
Phone No " 772-- O /F574
E-Mail:Ole/7oc)ctrciAea,�9&
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
City: State:
Zip Code:, . 097 Fax:
Phone No.
E-Mail: rlrA= c m ai Co%✓!
State or County License: �EC1100 SNb'Z
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION:LIEN LAW INFORMATION:)
DESIGNER/ENGINEER
Name: ;'
r Not Applicable
MORTGAGE COMPANY: ' Not Applicable
Name:
Address: --_..__,-
- --
Address:;
City.'
Zip:! Phone::
State:'
City - State:
Zip ' Phone:! -.
FEE SIMPLE TITLE HOLDER:
Name:
_' Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address: I
Address:
City: F
Citya __
Zip: + '-'Phone: ;
{
Zip: r Phone: i
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 andcovenantsthat 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 your Notice of Commencement.
Signa/��-,of Owner/ A
oof/A ee Sign tofContractor older
STATE OF FLORIDA STATE OF FLORIDA
_.
COUNTY OF, """-_ _1:L�_ . - -`. COUNTY OFi -.-.-
The s—r d g instr ent w acknowledged 1 before me The fVT, day
instr ent was acknowledged before me
this S day of 20 14 by this ll`> � day of (' - �' 20_1¢ by
(Name of perso�ackno�wle grog) (Name of person ac owledging )
(Signature of Notary Public- State btSlorida) ture of Notary Public- StatFlorida )
Personally Known? I OR Produced_ Identification i.
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Personally Known i I OR Produced Identification i
of Identification Pro duced-��
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Ty a of Identification Producedr-.-.._.._.___.�_� _._.__.
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Commission No. 'a „d,„ Se$ SHAHNAINGRAM
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:0:` k;`�%, NotaryPublic - State o1 Florid ,.•�;:a� ^6a••,, LASHAHNA INGflAM
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;'a°,' . -; Notary Public -State o1 Florid,
-• . . •= y Comm. Expires Dec 20, 7'
Revised 07/15/2014 '"' Commission r FF 177249
"'•,�1"�• ''.,�.tooa,. CommissionMFF177'
Bonded through National Notary Assn.
Bonded through National N assn.
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