HomeMy WebLinkAboutBuilding Permit Application »ate: ate' 15 Permit Number:
RECEWL-0 APR`22 206
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 frornt dropbox, click arrow at the end of line
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Project Name: w�r>t
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orme un er ispermit-c ec a appy:
&FIVAC E]Gas Piping _Shutters Windows/Doors
Electric 11 Plumbing ❑Sprinklers a Generator F�Roof
Total Sq. Ft of Construction: S •Ft.of First Floor:
Cost of Construction:$ /n Utilities: Sewer LJ Septic Building Height:
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Name: flmc? .� ,
-�d`cY1�C-
Address: . D - lv--r �b
•c C. Company: '' , p ,Ctut `� 102
City:• ,�[ �� `11�,rro.;r, State: t Address:,A(*)'!�N y N 1.• S _h�kabt!�jw
Zip Code:%Rl� Fax: City: State EL
Phone No. �1'7,� - �, ~' I I (•••� Zip Code: Fax: �'(�n� �_ a,
E-Mail: Phone No. )) '41L—S-7 1 f
Fill in fee simple Title Holder on next page(if different E-Mail:.��^c'r„n rY uz�'ta g�'���. 001, C-41."
from the Owner listed above) State or County License: L'I`l.,aLe
I f value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
9 # ZZL8i9tiZLL BL96Z9ti of :LUOJ�; 96 :Ms�-GZ-to
UESIGNERIENGINEM Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: i Address.
City: State-, 'City: State*
Zip- Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable I BONDING COMPANY: of 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 Horne 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,wails,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notic 6 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
commencinp,work or recording your Notice of Commencement.
77in-ature of Owner/Lessee/Agent 5i ature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY CIF�__
The forgoing instrumprit was owledged before me The forgoing instrument was acknowledged before me
fln
this,2a'?_day of 20 �by this,R2 day of wiL 20 a by
4-4
zs-
(Name of person acknowledging) (Name of person acknowledging)
(Si ature of Notary Public-State of Florida) (Sig lure of Notary Public-State of Florida)
Personally Known OR Produced identification Personally Known OR Produced Identification
P 0 0 Nil a
Type of Identl SANDRA Won Type of Identif!
SANDNX%Q99M Florida
ciary Public fava of Florida Notary Public of
Co Commission No
e lar 147
Commission N A I . 0 - Wv;VE my-Go
XP e Ar14,2018 mm.ExplitcSir 14,2018
F C? So Commission Commission 0 FF 0?1680 on FF 071680
Revised 07115 ZM4-
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS I L
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