HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z.�t zc) SCANNED
Permit Number.BY
1 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) 452-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ) IWO N" I1itr�S6 �� (AIr� �� f,
Legal Description:
Property Tax I M. _ 3q (Cc -- t 53=- 60 occ; _S Lot No. i
Site Plan Name: Block No. 13�1
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1
CONSTRUCTION INFORMATION: .
ACaitional work to tie vertormed un er is perms - c ec a apply:
�HVAC'' Gas sank El -Sprinklers.
Piping Shutters Windows/Doors
Electric L✓1 Plurnbing Sprinklers _ Generator Roof
Total Sq. ft of Construction: 5 _ Ft_ of First Floor.
Cost of Construction: $ 1 cS � "�0 Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name L4r)64 kil(ykl wy!
Name_ -),, )t.e-L (e i.IU'r
Company: J�, gtiT i �,ln o fC�2 ,�� Uyl r
Address: c,, A) tl) k f i` "O4[-� 2 � � •
City: — �7" f -0 I-f _ State:C.
Address:j
Zip Code: ��?J Fax:
irN
City: (,r �State: PIL
Phone No. S,11-71 of
Zip Code: Fax
E-Mail:
Phone No _ - j
Fill in fee simple Title Holder on next page ( if different
E-Mail: � ��,1 0,� < iy� �(• <<
from the Owner listed above)
State or County License: Clp)` 7-13 C el
w r�........� ��� ,c,o �....,.,�.��,�,■Duce yr wmmencementis regmrea.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Nam
Address:
Addres .
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable
BONDING COM NY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
certifythat no work or installation has commenced priorto 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 contlictwith any applicable Home Owners Association rules, bylaws orand 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 lender or an attorney before
commencinn w2EKHsecordingvour Notice of Commencement.
C"
f
u�
ignature of wnerJ ent/ L ssee
Signatu e o ContractorJ!" ense Holder
SLAT F FLORIDA
STATE OF FL
COUNTY OF ST
COUNTY OF S�.
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this a10' day of Olx 20 14 by
this =day of _ OCT"- ^, 20_.L4 by
-56,e
(Name of person acknowledging)
(Name of person acknowledging)
&I
r al A,. ,
(Signature of Notary Public- State of Florida }
(Signature of Notary Public- State of Florida }
Personally Know ✓_ORRIPr d e Id nt'fication
Personally Known l- OR Produced Identification
Type of Identifica on,,R�90u�ced KAREN a°�,
.10
� `A`"'
Type of Identification Produced
N Public - State of Florida
°�{�'
Commission No. StTm. 9R..Q Jun 25, 2016
�Yp KAREN 8£NNET7
Commission No. �={ ry public(slallj of Florida
F1 Camrniss?on # EE 194532
Boneed Thro?
• : ; • My Comm" Expires Jun 25, 2016
r o: 1 1632
Revised 07/15/2014 bonded Tt,rough National Notary Assn.
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