HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: ,S I ! ' �tp Permit Number: I l J()5 Mo
Building Permit Application MAY 17
Planning and Development Services PEPMiITTfNC
Building and Code Regulation Division St. Lucie County, L
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
-PROPOSEDkMPROVEME,NT LOCATION
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Address: 9-7 cS CLeP nl 1->& 11331 T6WC1 I ' 4
Legal Description: i 5 L-PW40 Z,UNCS 00N,00 A (,JIJ 17' 3 3 g llG I�t
A'OMtq*t, 6olvop (vtZ ?S%4 -
Property
S%4 -Property Tax ID#: 3S�S - (oo).- 004t--000 -Lf Lot No.
Site Plan Name: FPL eA6YL Block No.
Project Name: PP&P__
SetbacksFront_ Back:�Right Side: Left Side:N
DETAILED 6ESCRIPTION OF:,WORK h
CONSTRUCTION INFORMATION
Additional work to El
orme un er t is permit-c ec a app y:
HVAC Gas Tank []Gas Piping _Shutters gwindows/Doors
1:1 Electric F-1 Plumbing
, ❑Sprinklers ❑Generator ❑Roof
/
Total Sq. Ft of Construction: r A- S . Ft.of First Floor:
8
Cost of Construction:$ /�l NSU _ Utilities: _Sewer[]Septic Building Height:
OWNERJLESSEE CONTRACTOR:
. . ...
Name l(�(�F � r`7•Itr' Name: l
Address: 3�W'{ gArN 13wFg Company:-JENsa� uPq/iLc1/ti
City: Art State:tAr Address: ("72p NUJ F1r1�2AL l�w9
Zip Code: (o 21 Fax: City:- _51 lAl t— State:
Phone No. yp$5 Zip Code: 3W4)riY Fax: 032.-97L(y
E-Mail: 21 WPE►2 D t4- (P 60 L.-.cam► Phone No.—
Fill in fee simple Title Holder on next page(if different E-Mail: /1/!IG/ G✓i� � D
from the Owner listed above) State or County License:_� ,C
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CC7NSTRUCTIQN LIEN LAIN INF`f3RM,TIQN 3,
pp E
COMPANY: Not Applicable
DESIGNER/ENGINEER: _Not Applicable MORTGAGE
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 permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit 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 ail re to Record a Notice of Commencement may result in your eying twice for
improvements to your ro r Notice of Commencement must be recorded and po ed he jobsite
before. e first inspe io If u 'ntend to obtain fine r or a r y before
com en in ork r r i our Notice of CoiTfmencemente
6h�/uref Owner/Les a /Age t Signatu Contrac r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST /, COUNTY OF
The for i instrument was acknowledged before me The forgoing instrument was acknowledged before me
this
IZ=2!�4Y 20/Z2-by thiV�"tiayof�y 20/�by
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(Name of person acknowledging) (Name of person acknowledging)
(Signat of Notary Public-State of-Fiorida) (Signature of Notary Public-State o oRcla)
Personally Known 1// OR Produced Identification Personally Known LIXOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal Commission No. (Seal)
,a4` Y Pim, ANN M.GAUMOND arY ei ANN M.GAUMOND
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Revised 07/15/2014 Bo a dlThrSN t blb�un en�aes EXPIRES:December 7,2018
Ism`` ry R RO' Bonded Thru Notary Publ'c Underwriters
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
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