HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�j L0 _1 C Permit Number:
v Building Permit Application JUN 2 0 2.0%
Planning and Development Services
PERM1TTiMC.3
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address: 101 y ( S Oce .-, b(' Lo-1- &q7 �1a
Legal Description: &f.I1c_ CU 4, ,5 e_CAat,L 1-0
Property Tax ID#: SSI( TOS C)O,11SC - C>DO ^O Lot No.'
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Site Plan Name: r`64LK S fI dGr.0-C_ Block No.
Project Name: (,ertibcu.� I -ees. �G+ cc -
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK °`
(L e_,r►,,,J,e_ (Ze,P e f.+ er.--ter'/ (_v6
fur Z ��f` LASS T ZSSd 6t99fege
CONST- R CTION'INFORMATION'--'-
Additional work to be nertormed under this permit—check all the appy:
HHVAC Gas Tank Gas Piping _Shutters n Doors Windows
F] Imo. /
❑Electric 0 Plumbing Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:0_Sewer 0 Septic Building Height:
OUVNER/LESS:EE CONTRACTOR -
._.
Name(, dIs'o-, I Com:I L-_r A,1, Name. rl-J S `1-uLtd��.nn
Address: 10'70 I 5 DLazw. b r^ L,+. 6q'] Company: Cert, _J i,(,( lej y C o�
City: State:3::7L Address:3 Z-!>k _5E
Zip Code:.39Q Sn Fax: City: State: L
Phone No. Zip Code: S LI otq j Fax:
E-Mail: Phone No. I$
Fill in fee simple Title Holder on next page(if different E-Mail: C_sC SJ"l S Co r".
from the Owner listed above) State or County License: SLC Z 316 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN LAW 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 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 our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF "Allr7l 11i COUNTY OF HA rLT I Irl
The forgoing instrgment was acknowledged before me The forgoing instrument was acknowledged before me
this I'day of J U"'1L 20 1-6.by thisK—day of �(,L/'1C. 20 �by
(Name of person acknowledging) (Name of person acknowledging)
LClua�t- `�'1• � o
( 'gnature of Notary Public-State of Florida) (91g-nature of Notary Public-State of Florfda)
Personally Known V/ OR Produced Identification Personally Known 1ol" OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.l= F 1 (S SHAWNA M. omission No.Fid 131434o (Seal)
NOTARY PU LIC % r SHAWNA M. GE
RIDA NOTARY Pi igi-I
. Comm#FF131636 STATE.OF FLO DA
Revised 07/15/2014 ted fires 6/11/2018 Comm#FF131
t Expires 61111.98
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS