HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETE , . )R APPLICATION TO BE ACCEPTED � �n
l SCANNED Date: Permit Number:
SY
53t: 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) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
0ROFOSED IMRROVE V f LOCATION
Address: )L03 R ngle 'Rc). Focr Pi ec-C C'.,
Legal Description: ��t0.� ac,� Pay �e (3\K 1 -i'ha+ Part o Lot) d, L-+5 T'h rt,
I `1 Lois gO, �2 1,
Property Tax ID#:- S03 - cc) 01- 600 - 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.O.F WORK:
efI.Lit . nce C"h-4% elefen cpAl AAA ke /�.-��a-�� e P .,1 ,�fe.rr.�c.. .
CONSTRUCTION°INFORMATION.
Add itiona I work to be nertormed under this permit -check . all apply:
❑HVAC LJ Gas Tank []Gas Piping _ Shutters Windows Doors
10 Electric ❑ Plumbing ❑Sprinklers ❑ Generator []Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 12av Utilities:n Sewer ❑ Septic Building Height:
OWN_ER/:LESSEE:`
CONTRACT.OR.
Name V"Cr nn `1 prober-+
Name: C1kr;si-.p�e'
1
Address: I L 03 Angle 2
Company:
R -C% r)'oel Fl e cte,' c Tnc -
City: Fr- f> e r c LJ State: FL
Address:
36 8 6 En +e r e r �s e- 0-
Zip Code: 3 y 11 y % Fax:
City: Fort
P; E cc e State: PC -
Phone No.77.1 - aof - 701 L - Suay o�rAe� i-
Zip Code:
3 y 9 & Z Fax: 77.2- y Q - 1709
E-Mail:
Phone No.
'7'7 ,�a -Y 61- I qS 1
Fill in fee simple Title Holder on next page (if different
E-Mail:
Ccus e C c . Coe —
from the Owner listed above)
State or County License: G C n O D 19 to Is 17(,`la
it vaiue of construction is :�Zsuu or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION Lrtrd LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
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 lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of wner/ Agent Lessee Signature of Co ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St - Luc, e— COUNTY OF St • L u c ; e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this � day of Sc oi-e,.6ei 20 14 by this ZL day of Se p+er-% bee' . 2014 by
1.1 rlsfae6r W- R"Cke-'6'4C%r;s+oP�er 0-
(Name of person cknowledging) (Name of person Acknowledging )
C�.Olx 9-ag-I
(SignatureOf Notary Public --State of Florida ) (Signature of N ary Public- State of Florida )
Personally Known_ OR Produced Identification
Type of Identification Produced
Personally Known X— OR Produced Identification
Type of Identification Pr t�ced,_
Commission No. EC Jig 8�. (S��Y �IN��Y 'LJmmission No.
:n: 4
:": MY COMMISSION # EE11
Revised 07/15/2014 (407)39&0153
MY =(Sn )ON # EE117856
EXPIRES August 16, 2015
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