HomeMy WebLinkAboutBUILDING PERMIT APPLICATION11/26/2014 16:36 FAX
Ia 002/003
ALL APPLICABLE KIFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I1'a �� SCANNED Permit Number)
BY
St. Lucie COUnty
s
WIN Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial
Phone: (772) 462-1553 Fax: (772) 462-1578 Residential /1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 53o 64nun.w Coate Foyf-
Legal Description: LSD aml Flee A/A
Property Tax ID it: 34(0- ,'63- o38S- DOO '. 3 Lot No. 3_
Site Plan Name: Block No.
Project Name: -
Setbacks Front Back: Right Side: Left Side:
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itiona work to be-pertormed under tispermit-check a apply:
❑HVAC ❑
JI Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric LJ Plumbing Sprinklers 0 Generator L1 Roof
Total Sq. Ft of Construction: Sq•.Ft• of First Floor:
gam- OSeptic
Cost of Construction: 40 Utilities: II.�ISewer Building Height:
WV 8
Name %AbMAJ 110-4e Vf
Name: o
Address: 5.36 Ae? 4^- 64
Company: t % fhn ern t
City: fo /� D;C1r'1_ State: L
Address: CWSW v 2AO IV
City: QUA- S+. Lv.,-,2 State:
Zip Code: 346JF9o2 Fax:
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Phone No. -7y- 5e7-elf�'9
Zip Code: Fax:JJ-L'-4J1-!500
E-Mail:
Phone No. 811-')1
Fill in fee simple Title Holder on next page (if different
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E-Mail fotrsTa_ nn_� �GrtFran� Stn yawn r WM
State or County License: C F��yi,b 417
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
11/26/2014 16:37 FAX
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DESIGNER/ENGINEER:
_ Not Applicable
:MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone:
Zip: Phone:
_
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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)eader or an attorney before
commencine work or recordine your Notice of Commencement. 1
STATE OF FLORIDA STATE OF FLORIDA `/ /
COUNTY OF �S�G�G.L COUNTY OF lX G>�(t_.
The forgoing instru t was a knowledged before me The forgoing instrume was a knowledged before me
this�9ay of 6lkl✓ti' 20 14 by [hisday of Or/ 2D�4 6y
t
(Name of person acknowledging) (Name of person acknowledging) _
Personally Known
Type of Identifical
Commission No.
Revised 07/15/2014
Personally Known
Type of Identification Prodr
MY COXMJON#FFIG5n2! Commission No.
EXPIRE October 1. 2018 I "';5
1,2016
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