HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: Permit Number: l
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Building Permit Application JUN 2096
Planning and Development Services Public works
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: ox c I
Address: c L S
Legal Description: =�anC7 V I re�� �
Property Tax ID#: 5 a d-- i'n ool on 20 -- 000 Lot No.
Site Plan Name: Block No.
Project Name: Sol)d:I)Q 0Y- S 7za-1
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed un er t is permit-check a appy:
HVAC Gas Tank E]Gas Piping _Shutters 1 Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 14, 1 Ot . 5-3 Utilities:Cn Sewer Septic Building Height:
Name J a' 61117narnE:
Address: 'l LM O S. ()0 axabr. 123 A mpany.
City: J oncw Gaac'h- State: ELAddres v �
Zip Code: 314997 Fax: City: �L-h r Sta�te:
Phone No._ _51$ - 3 30 -?4Q I Zip Code:�L5� Fax; 7L/-R—ZS32
E-Mail: Pho o.
Fill in fee simple Title Holder on next page (if different E-Mai h W
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 recour Notice of Commencement.
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_Signature of O er e e/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF LORI ,—
COUNTY OF VVI
COUNTY OF 3 � l
fo oin instr�/ � t was ac owled a efore me The r oing instrument was acknowledg d before me
s day of V� 20 thi5�day of 20 Uby
PIC he-C'I (,_Vyy�4c�n
Name of person acknowledging) (Name of'person acknowledging)
Ignature of Notary P ic-State o Florida ) ignature of Notary7_011
tate of Florida
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Personall Known 'OR Produced Identification Personally Known Produced Identification
Type of Identification Produced ntification Produced
�(C C G tippy pt•• ELISA AR EPffO
Commission l�oy c�J p�� _ �,, MY COMMISSION F,E8558 �s1 n No.0 ZS (Seal)
EXPIRES:DeceP birUnde deB
1a Bonded Thru Notary
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Revised 07/15/2014 MY COMMISSION#EE 855825
EXPIRES:December 28,2016
Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS