HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
SEP 0 7 201-0
Planning and Development Services pEFl; ITTliNG
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 IIVIPROU,EMENT LOCATION n>
Address: (OO NK S OCE IJK 4ZO3
Legal Description: SEA IN kNOS Co"00 A-yr 7,o3 //o3 ( OV2 3N F-11 7
Property Tax ID#: y Sot BOL Ce->1I - cx�_I Lot No.
Site Plan Name: -3LAN1L Block No.
Project Name:
Setbacks Front �JJ k Back: N Right Side: Left Side: A-
DETAILED DESCRIPTION t3F WORK =k £
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CONSTRUCTION IN.FORII/IATION
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Additional work toe performed under this permit-check all appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric ElPlumbingSprinklers ❑Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ N3oD Utilities: Sewer 7Septic Building Height:
01NNER%LESSEE y CONTRACTOR
Name i( A FrAt 0rJ Name: Nty4*1 Lif-+
Address: 16OL4143 Company:_-jeNfEgg S � �C1u IN
City: 1 oggN 1130IC 4- State: V1., Address: 17 Zv MW r✓JI-t/LQ�L (C 7
Zip Code: 34,515-7 Fax: City: Qi A/Ir.T State:_
Phone No. 77Z-6o7-oZ45 Zip Code: 3Lf-�Ry Fax:
E-Mail: Phone No. &�2 - OO CIO
Fill in fee simple Title Holder on next page(if different E-Mail: A4(G( (Jr //A/�,.�q1 a CO"
T o —
from the Owner listed above) State or County License:�[„�' /S�O,� W�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPL°EMENTAL CONSTRUCTION LIEN LAW.INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: '�£7Q M o&A C,4 Name:
Address: 1363e g: NoVL14 Address:
City: Stater City: State:
Zip: 5T-7(,,o Phone: K2 S 2 vcu4") 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 applicati s are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming po 1 fences,walls,signs,screen rooms and accessory uses to anoth non-residential use
WARNING TO OWNER:Yo ilure to Record a Notice of Commencement may re I ' your paying twice for
improvements to yo r pr rty. A Notice of Commencement must be r ord d nd posted on the jobsite
befor th tins cti . If you intend to obtain financi , c ult w' d or an attorney before
co men IX or or r r in our Notice of Comme ceme
gffLt s
Siga6ture of Owner/Lessee/Contractor as Agent for Owner S' nature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si COUNTY OF
The for. Ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiay of 20/ by this� ay of S�i�/ 20/�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature o otary Public-State of Florida) (Sign at u r—e-o-TNUtary Public--State o Flbrida)
Personally Known c�-' OR Produced Identification Personally Known r/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
AUMOND ;,yytiY`ke��; ANN M.OAUMOND
MY COMMISSION#FF 173907 ;r :+. MY COMMISSION#FF 173907
E-1111-5,Decembei-7.2eiB RES.Bec Intim 7,2018
Bonded Th.Notary Public Underwriters 'S Rf 4P, Bonded Thru Notary Public Underwriters
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS