HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /� / Permit Number: V
• JUL 2 5 201r;
Building Permit Application PEWAITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
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: I L/n C<E L3C 100— of
Legal Description:R I i\1 ee Phi U0A�l
Property Tax ID#: iL�- 55�' L � y �" `I _ Lot No. 1
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
WC
- Of1 \ l��
C���- � �
CONSTRUCTION INFORMATION:
—Additional work to e e Orme under t is permit—c ec a appy:
VAC fl Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
L.LTH❑Electric 0 Plumbing Sprinklers ElGenerator Roof
Total Sq. Ft of Constructio�n:�;c�� S Ft.of First Floor:
Cost of Construction: Utilities. Sewer El Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name �+1r`� � '� Name:
Address: kQ0 �j \�tGtCk Company: ! ` �YK'�1Sr, ,
Cit State: Address: F2R
:
Zip Code: ���1�� Fax: City: State
Phone No. (1~1�� 3i ~ IF"S� Zip Code: S� Fax��l"1�)� N~a�
E-Mail: l Phone No. 3 "
Fill in fee simple Title Holder on next page(if different E-Mail: t')r 7 n --eY i C a(7lsj,:I �
from the Owner listed above) State or County License: G1C 181
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
;r
SUPPLEMENTAL CONSTRUCTION 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 rec2L&&your Notice of Commencement.
s
_Signature of Owner ee n Signature o Contra or/ cense Holder
STATE OF FLORIDA 1A STATE OF FLO�t(�A
COUNTY OF LQ("1i , COUNTY OF 1 f \C���
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this day of �
20 by this �jday of 20 )(.D by
(Name of person acknowledging (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notar blic-S e of Florida)
Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification
Type of Identification Produced la—n.L_ Type of Identification Pr
m._ ..��.�_• ��.=.d=-=.-^K`�." =� "' ;; LE3UE ZELAYA
Commission No. ,� b KAREN' S N �oftirilissi No. =•• .•e
r ) c F r _ MY T ION A EE222572
EXPIRES August 08,2018
C..r�:� •„r`����
u n e .COfll
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS