HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONIIALL�Wd LE INFO MUST BE CC, ' .ETED FOR APPLICATION TO BE ACCEPTS,
Date: ay��� SC Per itN k-4a4 LI
ANNED
BY
St. Lucie County
Building Permit A
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: `'( �4q b
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:1i
Setbacks Front Back:
Commercial
mumber. -(}ta 4
RECEIVED
pplicatio AUG 2 4 2011
ST. Lucile County, Permitting
Residential
To Select from dropbox, click arrow at the end of line
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_ Right Side: _
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Left Side:
Lot No.
Block No.
-
HVAC Gas Tank
_.. , ..".
❑Gas
F�9111 �-u,ecKdn
Piping
apply: .
Mutters
windows/Doors
Electric 0 Plumbing
❑Sprinklers
11 Generator
� Roof
Total Sq. Ft of Construction:
Cost Of Construction: $ 3 3 aco •R j
Sp} Ft of of First Floor: _
Utilities.. Sewer Septic
Address:9 Cf 4' O S o g xr C a t e_•
City: ensue ACptc/l, State: F1
Zip Code: % Fax:
Phone No. (,a'? g 9 13 f
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Address:
Building Height:
Cv..
City: L�; Fi l v� , i�cc , c, L� State:_L
Zip Code:33i1 I a— Fax: T'.4I - SSSS • cfoY1
Phone No. J�> l - S� 5s- . y 0 a
E-Mail:
State or County License: _C G 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is
Name:
Address:
City: State:
ZIP: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
ZIP: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
ZIP: Phone:
BONDING COMPANY:
Name:
Address:
City:
ZIP: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
_Not Applicable
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
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FATE OF FLOR�I A, `
COUNTY OFJ��
The forgoing instrup"nt was acknowledged before me
this�sDam j/J �aayofz7//IG a 26,Atby
Name of person acknowledging ))
Personally Known OR
Type of Identification Producei
Commission No.
Revised 07/15/2014 "rorta'" Expires 7/31/2018
STATE OFFTM f.--� r
COUNTY OF
The forgoing instr ent was acknowledge Cdy�, fore me
thi� day of IJ S� 20 _ by
(Name gf person
' ANGELA ypUNG
h1 EkPIPRrZ- N#FF951069
(signpture orotary Py51ic- State of lorida )'"Q0201NOW-'-''cas
Personally Known �L OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
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