HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONF-•
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 44 • IS Permit Number:
SCANNED
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• St. Lucie County
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Building Permit Application NOV 0 5 20)8
Planning and Development Services ST. Lucie County Perml[an 9
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description: Em cct rS Gon e1 (n rrmr n : c) & I un % % 10 Ll
PropertyTaxlD#: t1S0a7-Q40 •0085-0430-Co Lot No.
Site Plan Name: Block No.
Project Name: ke,(. CJ r6ol
Setbacks Front Back: Right Side: Left Side:
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Electric 0 Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ j 5 a ,S ( UtilitiestSewer ElSeptic Building Height:
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O�V�TRACTOR„
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Name L'(lcle,+h0C60C1
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Address: 4Go0 $ DCeGn �cWv tln�E 1104
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Company: �Q1 C}C�f rJF 6 L
City: �C-.nse_n " c h State: J� /
Address: = ?�? f i�� 25 -Fii 'Lf A✓
City: i is (" L� Stater`
Zip Code:Nq 5 -7 Fax:
Phone No.'? -) O "�� a7
Zip Code: l � Fax: J 4I
E-Mail:
Phone No.L 5I '3-,25 �I US a
Fill in fee simple Title Holder on next page (if different
E-Mail:
State or County License: L -3 o;4
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
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�5U T� L t']S'ftUGfl(�Nfl`IN LAWFII�FORMA?iON;f`
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DESIGNER/ENGINEER:
Name:
_ 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:
Address:
City:
City:
Zip: Phone:
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 intend to obtain financing, consult with lender or an attorney before
STATE OF PiebRlDAHaw � ,r
COUNTY Tl
The forgoing instr lent as acknowledge dbefore me
this day of 20 7{ �by
(Signature_ofNotSfy blic- State.of
Personally Knowil OR Pral
9
Type of Identifi tion Pr
Commission No.
Revised 07/15/2014
Q� c s
ig ure of Contractor/License Holder
STATE OF FLORI A
COUNTYOF Invi ParG�
The forgoing instrument as acknowledged efore me
this �4 day of V(. r. . 20 JL by
Jae--`?e,s D-001,
(Name of person acknowledging)
"(Sigl of Notaly Public- to of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
0. STRBET
State ofFlorlda Commission No.
a W 235235
ANG YO NG
AfYcOMA11 i� I FF951069
EXPIRES: April 12. 2020
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