HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: • j �1�i SCANNED Permit Number: I,-OaS9
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: To Select from dropbox, click arrow at the end of line P C
PROPOSED IMPROVEMENT LOCATION:
Address: 3 31 '' W cir I d GU 0 W
Legal Description: Po D• DO A Q eru QU_T CA4L{ 3.u`e5
Property Tax IOL
Site Plan Name: Project Name 1 I - oo $k(n.-�2vx .
U 4
Setbacks Front Back:- Right Side:
DETAILED DESCRIPTION OF WORK:
_T RAO&-
CONSTRUCTION .INFORMATION:
45JHVAC L' _l Gas Tank UGas
Electric 0 Plumbing E]Spr
Total Sq. Ft of Construction:
Cost of Construction: $ : y I oc)
11
-Left Side:
l 56xzz lD k
Lot No: _5�1
Block No.
un—uicUn do dppry:
Piping _ Shutters a Windows/Doors
nklers Generator El Roof
S Ft, of First Floor:
Utilities.. er ISeptic Building Height:
0
.OWNER/LESSEE:
CONTRACTOR:
;Name J 2 `yam, : __ -
Name ob ei4 S 'A-:(— S
Address:_ J.
.Company:.
"•City: &S+_- UC,L-e. State: jLL .'
Zipcode:'��f'3SJo Fax:
Phone No.
Address: 5%jS. \LI(n., "'8: C0 L-V.,
City:¢H- P%zP.(-C_e. -' State: FL
Zip Code: 3$qR% Fax: i)a Y(oo (oG5 2�
Phone No.)—)y
E-Mail:.
Fill-in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Sere I.% c-2, ® ro1bzr a-l'%-
State or County License: CC� G «1Lt(tZ/O
It value of construction Is 5Z500 or more, a RECORDED Notice of Commencement Is required.
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SUPPLEMENTAL CONSTRUCTION LIEN, LAW INFORMATION: III
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY: _Not Applicable
Name: _
Address:
Zip:
I certify that no work or installation has commenced prior to the issuance of apermit.
Phone:
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 inspectio tend to obtain financing, consul i lender o t a tney before
commenci��nrk o cordine you Notice of Commencement.
STATE OF FLORIDA
COUNTY OF C,+ I. L. C.: - C
The forgoing instrument was acknowledged before me
this day of . 05V . 20 14 by
Raherk god
(Name of person acknowledging)
Notary Public- State
Personally Known OR Produced Identification
Type of Iddeent is t' Prodyced
Commission No. •05 X55_r=ys:8is
!4
Revised 07/15/2014
Signature of Contractor/License Holder, .,
STATE OF FLORIDA,
COUNTY OF .5 k0ct_.e
The for oing instrument was acknowledged before me
this for
of roay 2014 by .
K o 6 ef+
(Name of person acknowledging)
Of
Notary Public- State of Florida )
No.
,J'.
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DATE ._ I
'"I .
COMPLETE
INITIALS