HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.....___. _T _-71
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a 5 Permit Number: 56 4a1
RECEIVED APR 14 2f
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.� ---- - wilding Permit Application St. �UCtg cou
Planning and Development Services my
Building arld Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential I/
cKi
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line r
PROPOSED IMPROVEMENT LOCATION:
Address: 1 3 /FS -5'J
Legal Descri tion: P-1 (%� 1 p aRIV U
Property Tax ID #: 3W 510 ~ 0152, -Pco Lot No. %
Site Plan Nat e: Block No.
Project Na e:
Setbacks ront Back: Right Side: Left Side:
FDEfAILE6, 'DESCRIPTION OF WORK:
t
CONSTRUCTION INFORMATION:
Additional orktobenerformed under this permit -check all that apply:
�HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electri � Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 7 7� Utilities. Septic Building Height:
I
OWNER/LESSEE:
CONTRACTOR:
Name a G C;h
S)
Address: I 11
City: O N- hilt C A' State: f�C
Zip Code: �3YgS2 Fax:
Phone No. %02 ' 7 2i - 57 57
Name: vk / L/
y�
Company: G (mot T e. 1 C_
Address: �1 OLT %Z
City: P-C,, L State: Fit
Zip Code: _� y ql? so Fax:
Phone No. '7? a- 777— 001 Q
E-Mail:
Fill in fee simple
from the Ow
Title Holder on next page ( if different
er listed above)
E-Mail: i V C Q co • cow
State or County License: c 6
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL.C.ONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State:
Phone:
City: State:
Zip: Phone:
FEE SIMPLE
Name:
Address:
City:
Zip:
TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Phone:
Zip: Phone:
I certify thatl 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
commencing work or recording vour Notice of Commencement.
_ Signature(of Owner/
STATE OF FLORIDA STATE OF FLORIDA
COUNTY O� Ai- L1,1ee, COUNTY OF.7t-Lt.IG,-Q.
The�f,Qro^ing instr ment was acknowledged before me
thisMa1 Y tia of Yl 206
;Name of person acknowledging)
(SignatureofNotary Public- State of Florida )
Personally nown L e i ic�`'tion
Type of Id nt rc�l A
oary
Commissi
Commission # FFj�367
� � piresApr`7���17
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this _iday of ( 20 1 by
571e')ry611-7 9�rS67V7PU
(Name of person acknowledging)
4At."',
(Signature f Notary Public- State of Florida )
Person n R-' Pr dent ication
Type o Idot'fiipti - n Pro
Notary Pu i
Commi sio Commission # FF 12367
s Apr. 25, 2�1y
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