HomeMy WebLinkAboutBuilding Permit Application •I 141i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .? LA/ Permit Number: 1�01 " OG39
RECEIVED
Building Permit A plica ion�018
Planning and Development Services ST. Lucie Couht r .'crmittinn
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential v
PERMITAPPLICATION FOR:
PRD�P,�0��,,SED UN1�R_O�VEM;ENT LOCATI
Address: 3v A"74yL
Legal Description: / 9-41041/- .SW l �7 �C oT ,�aw.1J3'& r`f
y �Ol � W�1/` Z,�ZM2� 0 .• ��y�
Property Tax ID#:�73�-*` !�' �a�.Jr'� �%� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDRUSSCRaIP
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CO'fSTR<UCTION I,NF®RMAI®N:
Additional wor to e pe orme under tis permit—check all that appy:
_Mechanical —Gas Tank _Gas Piping _Shutters J Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 2. yBIU.°n Utilities: —Sewer —Septic Building Height:
®UUNR LESSEE: OU i
C®'NTRACTOR:
Name 00AMI 41 Z# Name: O , / Jla�
Address: ae�t Company: !� D
'
City: f �'L Address:
f{� t�� State: C/
Zip Code: 4 ppFax: City: fie /?1� State: (�•
Phone No. 0y 3�/•' OZO`� Zip Code: 3 Y6 Fax: T.72-/W-9AOZ
E-Mail: Phone No ZTZ — .2A(— ?.? 69�'
Fill in fee simple Title Holder on next page (if different E-Mail „�I116 ladwej 0 6�"
from the Owner listed above) State or County License ���.!'70
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPR:L,EME T L CON,TRl1GTl®N LN LAW I NSIF®RMATIQN:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: NotA Icable
, paly
ame: 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 permitoolder to build the,�u�jeet structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and 6bveriar�ts th'i3t•�ay\cestnct orfprohibit such
structure. Please consult with yov Hoome,Owners ssociationrand review your deed.foJ any restrictions which may apply.
In consideration of the gra'nting of this requestb'_ per`rriit,l-db hd eby agr fh�I will;;in all'ft's)5ectg,petform\the work
in accordance with the approved plans,the Florida Building Codes and St. pjQQ- �ountMmen�{nen�tsS
•
The fall wing building permit applications are exempt from"undergoing',,fujI nourrency reviep:room additions,
accessory structures,swimming pools,fences,walls,signs,screen"rooms and �essois'uses'•to an'o he r- 'resideuse
�.,
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 recording our Notice of Commencement.
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Signature 1W,. .0
Wn'r/Lg
essee/Agent 5. Sign Contractor icerise, olde!rt ,r,
S .\'
� ,N, •i. .,• � • �•�.. am; �� .�..a e`. �.�: ._� '�• ''�'`. 9 .
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STATE OF FLOR�D .,,,,•,` ..r S7A7EaOF FLORIIDP ,.`'
COUNTY OF • 1: t� a : . , •; COUNTY OF'°"' : t, IY-Vie.`
The forgoing instrument was acknowledgeV before me The forgoing instrument mment was acknowledge before me
thisQy day of_S Vey ,20 1 by this�day of J x)\!o ,201 by
�d�� •car' A�S �o�ec � S +r.arlrl
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P blic-State of Florida) (Signature of Nota r Public-,Sta.te'of Florida)
Personally Known OR Produced Identification Personally Known OR Prbduced,ldenfA cation
Type of Identification Type of Ident_ification�-—";!' '
v _ .`' � hP1AS+SARSE GNEP1S093
Produced- \ r: "� "�` Produced p`. GG 022 :t r.
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SIS ��' ' ► 5 ��`�a"c' r't M
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y 0?2023 5 ry v11 R ,.l�- S Un ru�r le S .
Commission No;i1c"I � r'a�(4
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