HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLg INFOUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i i
Date: 711-7Permit Number: J 2 CC5�7 cYinp,
13uilding Permit Application
Planning and Development Services
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:
P�RQOS'EdD NP , ®1/EMENT LOCATI N:
Address: ('] 7 .S V3 ) �o,.r S�A; Lj)C c' �I�1,�� 6-Z
Legal Description:
Property Tax ID #: �� d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D ), L Gds ,q'V f A �o►ter more a) i fie_,Ts pr',^
aawl&L& o S -e— 4W-3 100
�chanical — Gas Tank — Gas Piping — Shutters _ Windows/Doors .
Y Electric Plumbing — Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ (2no, -C9-0
Sq. Ft. of First Floor:
Utilities: — Sewer _Septic ..I Building Height:!
Nam( IsP.,Vef 7 Address: ' 3 � I tjzr !-Y G Y _
n- -
city:. Ph-ec�L I N f _ 1114E State_
Zip Code: % -(> j;;-- i 02 -'Fax:"
_
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:— 9M. i A
Company: -f-TyC-&L'
Address: j 04R) S w je t. r1`C, ATG
City: 'F LD i Statee:L_
Zip Code: Fax:
Phone No 5'-6 i - t -i- +�;- Z —g 0 2
E -Mail �' -" STM� le -6862 Cm4Lt-
State or County License E 4-1130 l'1 SM
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUiPP0ENIENTAL CO.NhSTRUCTI'®N L1EN I_AW INf0:R11UlAT[O:
FRONT
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:
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 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 regording your Notice of Commencement.
Signature of 6wner/ Le/CoPSfractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA �r STATE OF FLORIDA
COUNTY OF COUNTY OF
The fQrgolng instrument was acknowled d before me The f oing instrument was acknowledgj fore me
this ay of 20by thiscZ of 20/ by
(Name c person acknowledging) /f (Name of person acknowledging) A
NotarN Public- State of FI
X
Produced ~\°n'��P Commission 7# FF 234730
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1111111_81 °� �. ._y 27, 2019
%°' Bond^d through National Notary Assn
Commission No. .___ —__--- (Seal)
c- State of Florida )
OR Produced Identification
rruuucea y HUFF
Notary Public - State of Florida
Commission NC
! ''- Commission ##0730
My Comm. Expires May 27, 2019
u Bonded through National Notary Assn t..
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Rev. 7/2014