HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 "�
Date: �/b Permit Number:
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Building Permit Application.. PE9r ITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL134982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 2s�4�;�TAh
PRN.
Address:77 77Tle.S 91yJ Jeg,eh z FG•3V%,57
Legal Description:�fi`�Ps y5/ahi� Z-9C• 35-2 Y _M/8
�i.
Property Tax lD#: L/� - 5-01-02 0.3 r 00-2 Lot No.—
Site Plan Name: Ile-&-ef Block No.
Project Name: 77
Setbacks Front Back: Right Side: Left Side:
DETAULED DE�SCRIIPTIOf� • F�[WORK: / J
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1(h✓TCla
COfSTRUCTION IiNFORMATI®N:
Additional work to be performed under t is permit-checK all that appy:
is
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows%Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: U�O Sq. Ft.of First Floor:
Cost of Construction:$ I70aoo Utilities: /Sewer _Septic Building Height:
QUVNER/LESSEE; ;, f ROMANO
C®Ni RAC'fiOR:
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Name AA�1 �aP- til y6; L 1,L Name: �,rvn �.,ifti
Address:-/?if S t/Y � Company:/�l /= dy„ 6�,i f!, ��cc� fug 'VG
-�1 7� State: L Address: �/j ✓I/E �SDenCe�- S7�
Zip Code: �� e): Fax: City: State:Fz-
Phone,No.. ;Zip Code;w„ 3y9�:' Fax: 771 J-32-.21571
r,
E-Mail:_ Phone No 771- ZZO ` 3 71,E
Fill in fee simple Title Holder on next page(if different E-Mail ec a rr�� `i il/�Jo Gq
p /� �.t" y/C � Y
from the Owner listed above) State or County License 66 125-1CIFI
R
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
�,&UIRR�WIMVEN r ffl* "F -MID
�_l.A1N IN��QRMATLON
DESIGNER/ENGINEER: _Not Applicable MORTGAGE CO Y: _ Not Applicable
Name: Name:
Address: Address:
City: te: City: State:
Zip: Phone Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicab BONDING COMPANY: Not Applicable
Name: me:
Address: Addr
City: City:
Zip: Phone- Zip: Phone:
OWNER/CON CTOR AFFIDVIT:Application is hereby made to obtain a permit to the work and installation as indicated.
I certify o 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 opyecording vQiw*eitice of Commencement.
Signature of Owner/Lessee/Agent Signature of Contractor/Licens oWer—
STATE
OF FLORIDA STATE OF FLORIDA
COUNTY OF VY'tCOUNTY OF r°'-1
Thefor oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 ay of® O,QJ`_k201�by this day A?C: D[nj, ,20_L1,0by
( ame of person acknowledging) (Name of person acknowledging) _
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identi ation Type of Identifi
d do
Produce � � Produced ��`L
Commission No. �� �� Seal)KIMBERLY AWAL Wmmission No. � � (Sean
/R t KI BERLY A.WALKE
NOTARY PUBLIC NOTARY PUBLIC
REVIEWS FRONT ZCITIT99PM BPLANS VEGETATION SE Wit
COUNTER REVI � ExIAM 3 REVIEW REVIEW REV 1I1� E pirR"4t1 (f2018
DATE
RECEIVED
DATE
COMPLETED
iev.7/2014