HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLEIINFOrffST BE COMPLETED F.,n APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
411111111111111111 BY
"tomii RMI-1,Bt. Lucie County
Building Permit Application
Planning and Development Services
Building and CoIde Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) i 62-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR:
Address: � I61 6 Y V j<I Ar , 14 w,,j
Legal Description:
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Property Tax IDI#:
13d- 5- 32a 000,1 000q Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Fro
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t Back: Right Side: Left Side:
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CQ.IUSTRI�J�CTItJ,NIN.ECIRMAT�fC�N
Haaivonai worK to De pertormea unaer tnis permit— cnecK an tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
V Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of C I onstruction: Sq. Ft. of First Floor:
Cost of Construl tion: $ ('a0d Utilities: —Sewer —Septic Building Height:
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,OWNER/LESSEEt_� ,L
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Name+alil' :..iy�c,Ca�ne SL.vers �v.c
;Name:.. �sr ec,✓ Z...�.�- ,..P+�G c=s1
:Company:'' i.' h{hul �C
'Add re"ss:'13�0i 04
City:, Vecfl. State: TL
Address:. 35
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Zip Code: `3 L4, Fax:
:Cityr: t-I i` ", __ _ State: —EC
Phone No. �I� c�—�t j P-5. `
Zip Code: 3ye, V-( Fax: �%C (7 10c)
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail: (t3+d Pay✓�T.i �L 6
State or County Licenser
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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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:
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. 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 lender or an attorney before
commenciniz work or recording vour Notice of Commencement. _
Signature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ; al Ltt C e— COUNTY OF =;�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of (Jr 20 IS by this CI dayof , 20j by
Z .'Z, L e_-6,& ► iie ra kA z7-r' C LiA o uk r i1 e ck a
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary P lic- State of Florida) (Signature of Notary P lic- State of Florida )
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. act&�®••""gip°•••., ( Commission Nol-ro'RoA� ?°t` `:'k; � qIS L WOOLLEN
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CH�� L-WOOLLEY v COMMISSION #FF0
'_€ MY COMMISSION #FF096403 • of r. EXPIRES February 26,201
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