HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY .
o
St. Lucie Countv
Building Permit Application 9.ECEIVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
DEC 0 3 'BIB
Tepartrnent
Commercial Re9l lomot county
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
M 6 P_ i?) Kr,
Address:
Legal Description:
Property Tax ID9: LISWL-6oa-om-000 -4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
CCIN31!RWG1UN�pit!LHiM�fa r N.,
U 7aufftlonal worK to be pertormed I=n s p rmit — check all I= apply: Windows/ . Doors
0 E]Gas Tank E]Gas Piping L Shutters
DElectric El Plumbing []Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: $ n/ �1 ��3 I utilities: Sewer 0 Septic Building Height:
Name" )he-r4a - VA,
Narrie;,'
�' -, - ' '. 1 1
1r�4
Addre�s: 40_61�20(621t
�qoj
% '-.=INATURALFLOW.'
C o m'Pa py:. �
Zip Code:
Phone No. 61,5L4- L+4 q- :p[cjor7
State: rL-.""
e
891 NE BAKER.ROAD
Add e. ss:: '."STUART,
FL, 34994
City:•
Zip Code:
Phone No.
State:_
Fax: 91A- 33q- 1078
11 _
E-MaflT6beeGLo1(A_rrA_ra e
Fill in fee simple Title Holder an next page if different
from the Owner listed above)
E-Mail:
bzc#A 60. ILL
State or County License:
2% t03
If value of construction is yz5uu or more, 8 KLLUKULU NOTICU al 1.
`5UPP EAENTALC®NSTR�1CtfON`LIENILAW
CNO�RMAfION
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
.s„tt1^ Y
_ Not Applicable
Address:
Address:
City:
Zip; Phone
State:
City:
Zip:
Phone:
State: _
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: 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 theissuanceof a permit.
St. Lucie Count makes. no representation that is granting 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 mncuriencyreview: 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
commencine work or recordine vour Notice of Cnmmencement.
Sig ature of0 ner/ Lessee/Contractor as Agent for Owner
Sign ure of Co tractor/License Holder
STATE OF FLORIDAnnp,,�
STATE OF FLORIDA ^�
COUNTY OF nnA'Q.TI Ji A
COUNTY OF ii�A{ m
The forgoing Instrument was acknowledged before me
1fE
The for oing instrument was acknowledge before. me
23dayof fd011(:r1'6kX(
this2ldayof P.f 20a by
this .20f by
ywy�i' M11 l i CA,
�\(AAS-k Mk li Gi
Name of per o making statement
Personally Known � OR Produced Identification
Name of p rsonmaking statement
Personally Known,- OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
l l'��%-C
� ,I 1 X Lq
b'v'�
(Signature of Not@ry)1WIc-§tate of Florida)
(Signature of Nc State of Florida )
Commission No.
rPublic-
Commission No. 0 {75
NofiiywuuW'�A�a ls,State of Florida
,,��4.-'."Notary Pyblw: Staleof Florida
JaHall
Donna Jayne.Hall
GG 207585
r?: Doyne
nna
My Commission
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x iras 04/1512022
p' o ' Ei'res 041
512022
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Rev. 8/2/17