HomeMy WebLinkAboutBuilding Permit Application U1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �`� ' I !' 162__ Permit Number: -k 0 "
Building Permit Application MAR 17 2096
Planning and Development Services PERNUTTiNIG
Building and Code Regulation Division St. Lucie Count , FL
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
-1-1 WIV19011111
Address:
Legal Description:
Property Tax ID#: JAZ- / too-I, -0 6 4 _000 — Lot No.
Site Plan Name: `tea 1 Black No.
Project Name: 96 ndR rs --
Setbacks Front Back: Right Side: =Left Side:
4
om
Additional work to be performed under this permit-c ec all tha appy:
ID1]HVAC Gas Tank ❑Gas Piping _Shutters Windows/Dpxo s..._
11 Electric F-1 Plumbing Sprinklers Generator 0-Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ^1 (e 0�2S Utilities: Sewer!_J Septic Building Height:
Name t Name: t P��`�`1`�cz i s°�S , ;cd i S-te�-
Address: $o1 -Q Company:a„�1�oC�� ?k�A-C A. Q.
City: State: Address:_1,.�, is 1 -79-1-H 0
Zip Code Fax:- --.� City: l ADs`f 1vy::ec--QJ,,,_ State:
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Phone No. 3 3 -' 1 } Zip Code:3SLI i a-- Fax: 51,I la 5.CA)a-
E-Mail: Phone No. 5 5 a- j C)S-
Fill in fee simple Title Holder on next page(if different E-Mail: -� S
from the Owner listed above) State or County License: L (o
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: ,�Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 pe'tnit.
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 ru[es�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,Ido 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 accessary 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 tie 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 our Notice of Commencement.
s
_tSignature of O.. nwO erlessee/Agent ture of Contractor/License Holder
STATE OF FLORIDA STATE;:OF FLOR A /
COUNTY OFO ,Lt�.,Q,t_� COUNTY OF A �t�►-t � C�Glt11'a
Th�org g ins 4rjen-t was acknowledged before me The for oing instrument was acknowledged before me
ty of-i nQ4 26/tp-by this,'day of l l tf ,20 i by
(Name of person acknowledging) (Name of person acknowledging)
L
(SlgnatreaofIVo Fu lc-State of Florida) Signature of N ary Public- tate o orida)
Personally Known Produc ation Personally Known OR Produced Identification
Type of Identificatio I1lYfAlYBt SSi��91 — Type of identification Produced
BotdodTbiuNo�tYPuSicUntlMrtNna
Commission Na. Commission Na.
ft ,YOUNG
# x MY COMMISSION N FF 951059
GINPIRE&A01 12,2620 1
4r'F�F Ft°S`� 80Dded Atu Budget Notary Serrloes
Revised 07/15/2014 ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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