HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Dates: 0 1 \� Permit Number:
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Building Permit Application AUG 0 2018
Planning and Development Services
ByUrllnrr rind rnda Rormintinn Mvicinn LST. ucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 it
II Phone: (772)462-1553 Fax: (772)462-1578 Commerciai Residential II
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PROPOSED IMPROVEMENT'LOCATION:
Address:
i9Legal Description:�Q
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Site Plan Name: G Block Noo..iL. Lam- 1
Project Name:
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From vain: :iigi:L Jiuc: L27L OWC. �I
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II I CON'S IRUCTiON- INFORMATION: II
li Additional work to he oertormeri tinder this permit—r_.heck all that apply: it
ell 11� :� a Fl �i I :�-•.l. a(
uiiVAC iuJ Gds Tank UGas Piping u 5iiuiter5 i � 'vvindows/Dours
Electric 0 Plumbing Sprinklers Generator of r§T()-] Roof pitch
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Name 2 Name:
Address: '"Z_ Company:"i���1
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Fill in fee simple Title Holder on next page(if different E- ail:
from the Owner listed above) Sttaa``tte oP'Cbun y Icense:
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�I DESIGNER/ENGINEER: Not Applicable nnnRTrerE rnnnpnniY Not App!Icub!p �l 11
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it I iNamei Natil:: li
it it"^ddr_ess: i�./.kcidress: l ��
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Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: ><Not Applicable BONDING COMPANY: ,-_�ot Applicable
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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
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i� structure. Please consult with your Home Owners Association and revie'w'your deed for any restrictions iuhich may apply.
(l In consideration of the granting of this reauested permit, I do hereby agree that I will,in all respects, perform the work
jjgpq in accordance with the approved pians,the Florida Building Codes and St. Lucie County Amendments. gelj
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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
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�0 commencin w rk or recording your Notice of Commencement.111i A" d Ji
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Signature f owner/.Lessee%Contractor as Agent for Owner Signat101F
f Contractor%License Holder
STATE OF FLORIDA STAT FLORID -)Cr
COUNTY OF saC. 1.y \e COUNTY OF
00iii� I The forgoing instrument was acknowledgell before me I The forgoing instr me t was acknowledged efore me
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Name of person making statement Name of persp making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificat on
Produced `��-IDV Produced
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;�� !I ,(sigrratur �f;i�lot�ry R St , IE GG022p23 $ ;(Snatltre of:N :otaS Ii -fit Le of:F:lodda,)
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Commission No. o; MYCOM �yec ��ecs
� otaNpub1iaUndecw Commission No.
p\RE AS AWRENCE
Bordea C�107�Cl"I Z'� fNOTARY PUBLIC,STATE OF FLORIDA
''•;goaa;°•• COMMISSION NO.GG 29721
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' MMISSION EXPIRES SEPTEMBER 13J 0
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IJF\I t i ., iI All
DATE
COMPLETED
Rev.8/2/17
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