HomeMy WebLinkAboutBUILDING PERMIT APPLICATION� � J
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date:
SCANNED Permit Number:
BY
St. Lucie County
Building Permit Application
Planning and Development5ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Plerce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1/
PERMIT APPLICATION FOR; To Select from dropbox, click arrow at the end of line
Address: IIJ Ic}'•7 t J rLr I -" L 1. _l -
Legal Description: AT- = _8LW--C"^ n��
00
PropertyTax ID#: 45i I I — l 00 J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front— Back: Right Side: Left Side:
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its na worcto
[epe(rformed
under this permit --cnecKau
❑Gas
M apury:
Shutters
Windows/Doors
HVAC
L J
Gas Tank
Piping
_
11
Electric u Plumbing
0
Sprinklers
[]Generator
Roof
Total Sq. Ft of Construction:
Cost of Construction: $ �5. c)—I'S
5 Ft. of First Floor:
Utilities: O Sewer 0 Septic
Name-1MAftZ�_) M . A'�Lt IName:=
Address 6harrfu Lr CompanW,
City: Pi f�l-i S : /1.2. Address:
Zip Code: Q Fax: Cim Lr—f
Phone No. Tye_ r Zip Coders
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or/Cc
License:
Building Height:
Fax:
State: ��-
if value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
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Not Applica
Name:
Address:
City: State:
Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name. _
Address:
City: I 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 Homeowners 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 your N_ ice of Commencement.
Signature of
STATE OF FLORIDA
COUNTY OF MAI-Tj
The forgoing instr ment was acknowledged efore me
this ay of j 20 by
(Name of person acknowledging)
0 r I a20j
L;:2L—
(Signature of Notary Pu ' - S to of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No E j f%%j (Seal}
CRYSTAL MARIE CRUZADO
2-. MY COMMWIDN # EE10746
Revised 07/15/2 EXpIAIEg,U.25.20ie
REVIEWS
FRONT
ZONING
SUPER'
COUNTER
REVIEW
REVII
DATE
COMPLETE
INITIALS
✓ISOR
.W
Signature of
STATE OF FLORIDA
COUNTY OF N 1�
The forgoing instrument was acknowledged before me
thisday o%jAj iLjcj irl_f----, 20A by
(Name of person acknowledging)
(Signature of Notary Pu c- Stat of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
CRYSTAL MA RIE CRUZADO
EXPIRES Jung 25. 2016
REVI W I VREVIEWON I SEA REVIEW
I MR V EWVE
60/ZO 39dd NIV H3d3EI N3SN3P TOZEPEEZLL LT:60 5TOZ/90/T0