HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� '969—, SCANNED Permit Number:
BY
-= 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) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED lIVIPROVEMENT LQCATIOi� 'Yid YID
r i _a 6 ►:
Address: AL �l
Legal Description: ( L Dom- (0 •SLO 0 2 Q tD1
Property Tax I D #: INO 5 ^ EQ l erne) -- nn " ( Lot No. P
Site Plan Name: Block No.
Project Name: \ � Ca Ci 1�1
Setbacks Front Back: Right Side: Left Side:
DETAILED CRIP DESTION QF 1NURK
ptje Cir,n5e . S Y �� �rrQf12; 14TT tco; Q AID 5 0$
Additional work to be nertormecl under this permit— check au that apply:
EHVAC 0 Gas Tank ❑Gas Piping 1:1Shutters F]Windows/Doors
Electric El Plumbing Sprinklers 12 Generator E] Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
r' n
Cost of Construction: $ `iD �� Utilities: _ Sewer Septic Building Height:
QWNER/LESS
Name n al) _
Address: l.�•
Name: Ue u
Company: 6�4he _ f
City—,FnY-� ,-e(ee; Stater
Zip Code: 3�lp 1 Fax:
Phone No.�l�2-- Lh � "��J�}�]
E-Mail:
Address: 0 mt�
City: 1' (� 2� State:.Ft-
Zip Code: I Pi2 Fax: �%7`2 -1 ItA�f `S
Phone No. -772�- 46 � � - ICoOi-
E-Mail: CA ant n
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
State or County License:
If value of construction is SZ500 or more, a RECORDED Notice of Commencement is required.
i
DESIGNE
Not
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: 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 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.
re of Own
re of
Holder
STATE OF FLORWA301� r STATE OF FLORIDA `
COUNTY OF •P� COUNTY OF S(Ql f`!� �+%le�
The forgoing instru ent was acknowledged before me
thls�p
day of g4- 20 14 by
C�4�u2 I � �(J �t ✓
kawt.,
,Name of person acknow(WIpa,Z,.
The forgoing instr ent was acknowledged before me
this& day of A- 20.,g by
ML4t( l 7T)UrhnM
(Name of person acknowledging)
v5� 2ore9 •• %' of PgRAL •••• ,'���"//�
EXPIq'•. i
(,ignature of Na`t ic-Sjpt�ofARV (Signature of Nota a o da) ; ys
ELE
Personally Moak (ol ' Q entification Personally Known _OR'�'c�Iua�d�Ter�t�j�t�n
Type of Identific3�yeLhrpduce&?�kQ�, Type of Identification Prod$ced.�AA
Commission No. (Seal) Commission No.
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Revised 07/15/2014
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