HomeMy WebLinkAboutBuilding Permit Application ALL APPLI ABLINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) //��
Date: , (, Permit Number: ( 1 V F r "1
Building Permit Application JUL 21
Planning and Development Services
PEWdllTriING
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
X Residential
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR:'
To Select from dropbox, click arrow at the end of line
PROPOSED`fMPROVE-MENT LOCATI"ON,
Address:
Legal Description: ISCA4Q _7065 CaW400 ori 1-r A
C2wno (oit
Property Tax ID#: S�� —eD - 00 35-—000- / Lot No.
Site Plan Name: �Lv�J Block No.
Project Name:�' 1[r(=�✓/"
Setbacks Front' Back: Right Side1�_Left Side:-
DETAILED DESCRIPTION-OF 1NORK:
�cnrL I��- GW?v r 141 oP�1^16 r .
CONSTRUCTION INFORMATION
Additional work toe e orme under this permit-c ec a appy:
HVAC El Gas Tank ❑Gas Piping _Shutters Windows/Doors
EElectric ❑ Plumbing Sprinklers Generator _Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ ZI ,700 -02 Utilities: _Sewer Septic Building Height:
OWNER
COaNTRACTO
Name A-r Name: G "A/Jt'/'�!
Address: � P. (,- J Company: T®uC�l (�/tUTf- Am i,✓k ry
City: S'f n Y i,f 06* State:�� Address: 171 0 IWW f' � 7
T
Zip Code: u J Z5S— Fax: City: S 7— State:r2
Phone No. 51`7 — �JgC1 -3Yk I Zip Code: 3K9yy Fax:OZ-97gy
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: /l(Gx�C ?�G✓/Nay '�
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C�NSTRUCTIQN LI,ENIAW INFQRMATION
, .
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 failure to Record a Notice of Commencement may result in r aying twice for
improvements to your pr pe7ontend
otice of Commencement must b e rde n ed o e j bsite
before the fist in pect' n. to obtain financing, consw' en r ttor y be re
commen 'n w or ec n Notice of Commence nt
s
_Signature of Owner/Lesse gentry— � Signature of Contractor/ ense Holder
STATE OF FLORIDA STATE OF FLORIDA /
COUNTY OF COUNTY OF (!Z/—
The for o'ng instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi._ ay of VZ_ 2Q��by thi� y of JUGS/ 20�by
(Name of person acknowledging) (Name of person acknowledging)
(Signa f Notary Public-State of Florida) (Signat f Notary Public-State of-Rorida)
Personally Known ✓ OR Produced Identification Personally Known "/'-OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. _
�,•i�hY y4•• ANN M.GAUMOND
MY COMMISSION#FF 173907 ni,;�R� `Y ANN M.GAUMOND
ecem er 2016 - EXPIRES:December 7,2018
Revised 07/15/2014 '� Bonded Thru Nota Public Underwriters y`� c•`
P,d Notary uF F°o` Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS