HomeMy WebLinkAboutBuilding Permit Application L �
ALL APPU I( LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ¢�3 1 l� Permit Number: �� • �1
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Building Permit Application
Planninga d Development Services
Building an Code Regulation Division
2300 Virgil ii'a Avenue,Fort Pierce FL 34982
Phone: (7T2)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line wiN-po-d[ cC=K_
Address: 12 Z J�1')ov'( ��D Ci✓
Legal Descr�ilption:
L.at�s � '� �q
Property Tax ID#: '!5Q I 01 'd 3 Lot No.
Site Plan Name: �Aifd J �5:n so", Block No. D
Project Name:
Setbacks I Front Back: Right Side: Left Side:
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Additional�wor to -e e orme uncler this permit-check all appy:
11HVA Gas Tank ❑Gas Piping _Shutters Windows/Doors
DElectr is ❑_Plumbing Sprinklers FIGenerator ffRoof
Total Sq. Ft;pf Construction: S Ft. of First Floor:
Cost of Coni truction:$ �iC�� ( t 1 _ Utilities: _Sewer E]Septic Building Height:
Name it rig! c Name: Peter Cafaro III
Address:, Company: Lowe's Home Centers, LLC LJ
City: (� � �}.)- ,. — Stat ✓� Address: P.O. Box 781993
Zip Code: .3 kf C(YFax: City: Orladno State:FL
Phone No.i� Zip Code: 32878-1993 Fax:
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E-Mail: ; Phone No. 1Z 2- I-(1u c�'t S�
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Fill in fee simple Title Holder on next page(if different E-Mail: L° • co
from the Owner listed above) State or County License: CGC150841
If value of 16struction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW IN,FORMATION: .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: j Zip: Phone: i
FEE SIMPLE TITLE HOLDER: YNot Applicable BONDING COMPANY: Not Applicable
Name: Name: '
Address: Address:
i City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 thee 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,per-form 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 propert . A Notice of Commencement must be recorded and posted on the jobsite
before the first inspe yo intend to obtain financing, consult with lender o orney before
commencing wor recordi Notice of Commencement.
Signature of / ent/Les e• Signature o Contra ' r/ i nse Hol
STATE OF FLORI STATE OF FLORI A
COUNTY OF sic COUNTY OF 5«
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jThe foreoing instru rt was @cknowled e before me The forgoing instru nt was acknowledge ore me
thistcdayof 20iy this3Mdayof 20y
Peter Cafarn III f Jr` -� Peter Ca`aro III
j (Name ofp�yso ackno ging) - (Name of person ac egltn
(Signature of Notary Public-State of Florida) (Signature of"Notary Public-State of Florida)
Personally Known X OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Se&IfhCH BOCOOK Commission No. BOCOOK j
- ``} -
Notary Public-State of Florida '• Notary Public -Stale o1 Florida
'•• Comm Expicn�Mel-f' 916 -' • • ' -fao+�ez 148Y7'2
F yrs- Commission #EE 176869 Comm ss r,n u EE 176869
Revised 017/1-5/20
Bondeo ihrouoh National Notary Ass 4w""�� Bonded Through N,;rona'Notary Assn.
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