HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RIC
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a r,
Building Permit Application MAY 17 2096
Planning and Development Services PERMITT1,Nc,
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial --Y,— Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED Ml.01/EMENT.LOCATION .. .
Address:Legal Description:Description: —rl+� AA 12o� NtAy2 1: uN I T 307—
Property Tax ID#: 45_0-= 702- (,,00'7— OOJ '7 Lot No.
Site Plan Name: Fe-LIC.I Block No.
Project Name: �f:i L1 C.,Setbacks Front -1 K Back: 'v A' Right Side: ti 4 Left Side: N
T—
:D�ETAILED DESCRIPTION OF 1NORK• a
'PVRACrZM erjr C� OPS,lNGSC 67C l?IA1 6
CONSTRlJCTLON:INFORMATION.
Additional wor 'toe ,e orme under this permit—check all-fl appy:
11HVAC 11 Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric ElPlumbing Sprinklers FIGenerator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:0Sewer[]Septic Building Height:
01NNER/LESSEE ;' CONTRACTOR
_.. .
Name ��1 L i To"tJ $ sus Name:
Address: lcl(oa aeytrz V/L $- 30Z Company:
City: ,S(SEy State: PL_ Address:
Zip Code: 3L(11-5 ' Fax: City: ,)' State:
Phone No.�ti�l) SLy—Sg�� Zip Code: Yy511 Fax: L�'17Yy
E-Mail: Phone No. f 7,-ax?
Fill in fee simple Title Holder on next page (if different E-Mail: G (/✓/w
from the Owner listed above) State or County License: C f S-6 8 K?i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENLAW INFORMATION:
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 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 failur o Record a Notice of Commencement may result i your paying twice for
improvements to your prop rty Notice of Commencement must be recorded a d osted on the jobsite
before the f' intend to obtain financing, sult with I d/err n attorney before
com ou tice of Commence
s
_Sign of Owner/ ess a/Agent A6 1%C7f– ature of Confractor/LicYnse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF- COUNTY OF
The forgoi g instrument was acknowledged before me The forgoing instrument was acknowledged before me
this/ of G9 20/�by this�� y of 20/10 by
(Name of person acknowledging)' (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) (Sign re of Notary P lic-State—of Florida)
Personally Known L,�' OR Produced Identification Personally Known : OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
:o4�Y ey'• ANN M.GAUMOND ANN M.GAUMOND
_.• EXPIRES;December 7,2018 EXPIRES:December 7,2018
Revised 07/15/2014 = Rf�o;. Bonded Thru Nalary Pubic Undenvrlers ''S Rf �Rp' Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS