HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1Q..' 2 1 17 Permit Number: 1 "
RECEIVED
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OCT 26 2018
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_ Building Permit Applica '$ ftilgleCOMM P&MIlting
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
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PERMIT APPLICATION FOR:
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Address: 100 &i570LA TDi2. �Y 9ff SLB2 -
Legal Description: l32 ,,
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Property Tax ID#: 3LIO , 'SG 1 06613 00,!2LI Lot No. 3A-
Site Plan Name: Rt-7g 1 P-a,Zer Block No.
Project Name:
Setbacks Front Back: ' Right Side: Left Side:
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Additional Work to be performed under this permit-check all tat appy:,
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing. _Sprinklers _Generator Roof KV,--CPitch
Total Sq. Ft of Construction: 94f SD �'Sq. Ft. of First Floor:
Cost of Construction:$ d��lJ�J�oo Utilities: —Sewer _Septic Building Height:
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Name f:lJ i =.�c �_ (/�cW o+N�►c Iyn Name
Address:' i f-ij* 'Ofii Company: LLIC�
City: li State's Address: ��Lid�c �4i�'�7yLcJ�
Zip Code: z.` c1.�2.;.: Fax: _ City: =} �C� _ Stater,
Phone No. -21-2— :34k Vii, S"-2 Zip Code:3�MK2- Fax:
E-Mail: Phone No '77-?, -;,2
Fill in fee simple Title Holder on next page(if different E-Mail I
from the Owner listed above) State or County License 6CC.-v �s'�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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Sl.i'v PLENIE� C(aNS�`,� ��IOt`�lI INtp► marm
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: I/Lc ��v•�L C_� �5 e— Name:
Address: 90to Address:
City: f'c 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 toy pr perty. A Notice of Commencement must be recorded and posted on the jobsite
before the first i pectipn. If you intend to obtain financing, consult with le or attorney before
commencing w rk or our Notice of Commencement.
SI nature of Owner Contractor as Agent for Owner Slgnatur of Contractor/Lic older
STATE OF FLORID STATE OF FLORIDA j
COUNTY OF COUNTY OF
The f r oing instr en was acknowledg before me The oing instr s acknowledge Ie me
this day of 20 by thigof M� _ 20by
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Name of person making tatement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public State of Florida) (Signature of Notary Public-State of Florida)
�`"AYDff� KAREN KA(139M)S. NIELSEN
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Commission No. ,,f �a% Sd�l LSEN Commission No. o YP�,,-
of Florida-Notary Public �: -State of Florida-Notary Public
Commission # GG 207484 '• Q° Commission# GG 207484
'��qin�"` June 12, 2 22 ��nin�`�`
Judd 12, 2022
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