HomeMy WebLinkAboutBUILDING PERMIT APPLICATION>v rr
ALL APPLICABLE INFO MUST BE CO _ !ETED FOR APPLICATION TO BE ACCEPTED
Date: L —
SCANNED Permit Number. _ Iff Q Ip
R.:., BY
St. Lucie County
Building Permit Application RECEIVED
Planning and Development Services APR 2 9 2019
Building and Code Regulation Division
2300 Virginio Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial St Lucie county
Residential
PERMIT APPLICATION FOR:, To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID#: `fSOa -GdQ-00947--000 Co
Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Front Back: Right Side: Left Side:
ckcrne_ auClcor{b) f)G SIZ -C C.Msae j- i;MTk- r
)
--._..-...-..• •�
❑HVAC
wM1 5WI 111cu
_Gas Tank
uiwar uua perrna -cnecK an
❑Gas Piping
M appry:
Shutters
�/
E wmclows/Doors
L_IElectric
El
0 Plumbing
❑Sprinklers
E Generator
1-1 Roof
Total Sq. Ft of Construction:
Cost of Construction: $
5 Ft. of First Floor: _
UtilitiesSewer D Septic
Building Height:
;OWNER%LESSEE, s
CONTRACTOR 4 t
Name-. . ( nS Ford
Name: L�S7 t..i — Cx
is Esc �E
Address: 3 3la Sir C0ey-A Ise- bc6 c.
Company:— Go QC'%
City: S Uei r t State: E1
Zip Code:.7 ci qg, 7 Fax:
Phone No.7i0-C3/Q37G
s\
Address: V . `7 T 1
City:1 , 4'a•: k C,r C-
Zip Code:33yI a- Fax: L,I.
Phone No. 51!t - SS`.S�
State:_F
5S•�fuS
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: L (r-) < n .:ka�i 3 I
,f value or construction is 52500 or more, a RECORDED Notice of Commencement is required.
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: Not Applicable
Name: —
Address:
City:
ZIP: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
which Is In conflicctt with any applicable lHomeaOwners tAssociation rules abylaws or and covenants that build
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
comme�lcing Work or recordine vour Nntirn of r,,.,,.,,e..,.,.....,._.
STATE OF FLORIDA rn STATE OF FLO D/�
COUNTY OF COUNTY OF �, I, L
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged�pefore me
this Jl�. day of �. 2p ! tjby this � day of �� r, ` , 20. �1—r---{I— by
1 �l
(Name of person acknowledging) V.(1�y,15
(Name of person acknowledging)
R(SCJr nurse MOM t-ero 1orida (Signatur of Notary P lic-stat of Florida ) Personally Known OR Produced Identification Personally Known --��OR Produced Identification
Type of Identification Produce f Identification Produced
Commission No. =R'�GGtNM J
ission No. inyP/y� pNGEAA
EY•y_.o.... i
'+ �illay iF20Y2 MY COMMISSION 9 FF951069
Revised 07/15/2014 "'Fo oa 6awea TinBudget Nowy SeMcos
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