HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '�\C9 N\A Permit Number:
FR'C
EIVE®
Building Permit ApplicatioEP 0 6 2018
Planning and Development Services e County, W@rrnitting
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: To Select from dropbox, click arrow at the end of line
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M'T PROVEOCATIO'N�
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Address: 16Z"116 ling J aK f`�I�GF 0.0 V6
Legal Description: S61t7'l SI44P.E U/i crge U/Vi7 Z'-L
Property Tax ID#: 167-A0Y6 -j40/ Lot No.
Site Plan Name: T141/19-b FONNFk Block No.
Project Name: �l�K/ � 1__6NAJEfl_
Setbacks Front Back: Right Side: Left Side:.
`::DETAIL ED DESCRIRTION OF'WORK.. t
J�i(SS7A-L44T,(0 J a AIM016ru /-Pu,�2l ur �SlSlu`77� 5
CONSTRUCTIONkINfQRMATI'OM'`-
Additional work to be erformed under this permit-check all=appy:
HVAC Gas Tank []Gas Piping IV I Shutters a Windows Doors,
-Electric ❑ Plumbing -Sprinklers _Generator Roof
Total Sq. Ft of Construction: --S . Ft. of First Floor:
Cost of Construction:$ 1019•�� Utilities: Sewer-Septic Building Height: J`
_OWN,ER/LESSEE ;
_ CONTRACTOR
Name /llN'Gle_ Name: dYMLHAfr=7 f
Address:_ k2j-/!/' RAMOUR 7/ 1 b(,r /it 4 Company: X-17U2 edi�P
City: ?Aal au State:T_ Address: ZAH SE S o lel fue- i?I W
Zip Code:34M Fax` City: 190Lr,k&M 1) State: 6L
Phone No. Zip Code: 33JfJ3_ Fax: 772-5/15--3.2R
E-Mail: Phone No.77d- 33o6
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: aba.5�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SU, TA
-F`P� MF-N LCONSTRUCTION-LIENI-A
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:
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
comrp&TTwng work or recording your Notice of Commencerngnt.
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—Signature of Owryer/Lessee/Agent Signature of Con facXVLicene Holder
STATE OF FLORIDA STATE OF FLORIDA
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COUNTY OF_ ;i!�, COUNTY OF
The forgoing instrument was acknowledged_,before me The 4ay
Ing instrument acknowledged before me
t day is
his of agQ L_ 20 Ibby this of 73�� 20 by
(Name of person acknowledging) (Name of w perso
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(Signature ofl�o�tarNF ublic-State of Florida (Signature otary Public- Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.nl06 1 IoLkR (Seal) Commission No. (Seal)
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Revised 07/15/2014 Notary Public-Stat*01 0' hatarypubji, COOK S teofFlorlda
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