HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: >'`!/ Permit Number: L [� flJ
RECEIVED
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Building Permit Application OCT 0 41018
Planning and Development Services Permitting Department
Building and Code Regulation Division St.Lucie CounN
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: R�J e-f r F-- Pi erce FL 3V99
Legal Description: (N
Property Tax ID #: `t 3t' S Z , . i -. C'G . G Lot No. 1 ( -
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CN s i t (a 1 5-r 4ke du"r- l02 X 7 d4c
Additional work to be performed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ l e)e_ i,_6rj Utilities: —Sewer Septic Building Height:
LTs.
Name zle Vd k Name: !74.4 C A,r;C,
Address: 137 Company: Z 7ecl1 6ora4c, dcc�r
City: %-f �.'tn�tL State:Zi� Address: H9(e
Zip Code: 3(/r(k! Fax: City: r3z State:%c
Phone No. 7?.2_ S/9- C�/S� Zip Code: 311?k3 Fax:
E-Mail: Phone No 772 1ZSL!2z' %
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License Z
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
M MEN
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 recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF `64-. '%-e COUNTY OF �Sk,
The forgoing instrument was acknowledgeq before me The forgoing instrument was acknowledgebefore me
this day of S,%,p3 20 K by this S day of 5-.tA 20% by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary ublic-State of Florida ) (Signature of NotVy Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced c-- Produced t {PL.
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Commission No. 'S ENS Commission No. �... 22023
NA p22025 zr COMMISSIO
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MtMIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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