HomeMy WebLinkAboutSUBMITTED PAPERSALL APPLICABLt INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I3�i� SCANNED Permit Number:
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 V Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
L'PROPbSED II�PROVENIENT LOCATION:
Address: Iyll kD
Legal Description:
Property Tax ID f!:'�';1)2-I' a ()C) - C)Cj(-) 1 - OC)U —4- Lot No.
Site Plan Name: Pal A C Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:_
Ruh e-VA�-cis r 3 g S l i W-0-
f rONSTRl1CTION INF(7RMATInk'
E1HVAC LJ Gas Tank 0Gas
11 Electric 0 Plumbing E]Spr
Total Sq. Ft of Construction:
Cost of Construction: $
Y
nit - check aapply:
Piping _Shutters
nklers Generator
_ S Ft. of First Floor: _
Utilities. Sewer Septic
Windows/Doors
EIRoof
Building Height:
=OWNER/LESSEE; Fx '
CONTRACTOR
:
Name PC, a V)�V-C' l M
Name: C
CI Eiil i I �n
Address:OlS 1 SW C a C11 U.6 VY-
Company: F I I f-C CEO C Coki-WQl Eft YS
City: �b YA- &-E. \ UCif, State:
Zip Code Faxes
PhoneNo;.�_" lel .
Address:Ql-_�,S'Ikf P01110 M
City:'pt �C I � 1 Stater /]
ZipCode:2t"IaC) Fax: Z.- .. -Ii]7I
Phone No. 1 -t - 6-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 0 C
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
TA
IMSIGMER/NNGINEER"��Not
Applicable
MORTGAGECOMPANY: NotApplicabie
Name.
Name:
Address:.
Address:
City: State: _ _
City: Statee
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLEHOLDER, _ Not Applicable
BONDING COMPANY:, —Not Applicable
Name:
Name:
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 the Issuance of a permit.
.St. Wcie County makes no represegtation that isgranting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Homeowners Association rules, bylaws
. or ancovenantsthat 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 o 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. Yourfallure to Remrd a Notice of Commencement may result in your paying twice for
improvemen s to your property. A Notice of Commencement must. be recorded and posted on the jobsite
intend
before the r t ins ection. Ifyou to obtain financing, consult with lender or an attorney'before
comma in w orrecordi our Notice of Commencement.
.5i at' w er . , n see
Sign u of Con raetorj icensei Holder
S ATE OF FLQR�D
STATE OF FLORI A
COUNTY Or IV 1 I r) Yl
COUNTY OF p r—i
The forgoing in-ktrument was acknowledged before me
this davofhJ�Wj)abrr:26J4by
The f�o,r,goins instrument was acknowledg�d�'pefore me
this of MIN P,il']jCt�:20,�by�
�.
(Name'of erson acknowledging)
(Name of pers n acknowledging)
g ature of Notary Pub - tbte of Florida �tCAU
t i ature of Notary Publibz.416ite of Florida) uS1'
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