HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE Ca - ETED FOR APPLICATION TO BE ACCEPT_ '
f n Permit Number: v)btyrl' " ()I I i3
Date:
".� RECEIVED
i-tea.• :, 1-
DEC 312020
Building Permit Application Perrn►t1
1
11
9Department
Planning and Development Services St. Lucie county
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: SW1..na.A,?/X-J 4 AaJ/
Address: c-/ % q ! -e Q5 77P -72,4/ L
Legal Description: /8.3 S1J46 5 Z�&NW,�&QAAJE- � eF A% ZVd A NA%
PropertyTax ID #: Lot No.
Site Plan Name: Block No.
Project Name: x UG/ /V c
Setbacks Front_ Back:
l U Right Side: % v -Left Side: /V
i
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
1llectric plumbing _ Sprinklers — Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ =2:21_9Qy •� Utilities: —Sewer Septic
Name -F--,,'PrV /U
Address:
City: ;-r:� er State
Zip Code:C3 961 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Company;
Windows/Doors '
Roof
BuildingHeight:
i •� t'r"}rf5i: r. R •aS!" 2��rj : 3 —
_�EKr�tii t�. J .•' ;,�71 � i3� •i xy �i. �{ �•
iirr
City:Yf'T b JeStater
Zip Code:3 Y9.9 2 Fax: q6 :5 -/ ei t 3
Phone No 0
E-Mail D d
State or County] icense
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:-Application is hereby made to obtain -a perrnlfto 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 dpermit holder to.build the subject structure
which is in conflict with any applicable Home Owners Association.rules, bylaws,or•an covenants that may restrict or prohibit such
structure. Please consult with your -Home Owners Association acid review your deed for any restrictions which may apply.
In consideration ofthe granting-of.this'requested,.permit, l 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-aceessory 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 recordin ,. our Notice of Commencement.
G
.
Signature of Owner/ Agent/ Les /Contractor
Signature of Contrador7iLicense Ho der ..
STATE OF FLORID /'
STATE OF FLORR.y
/
,
COUNTY OF �%"' & �--LJ
COUNTY OF sStl�C/
J
The forgoing instrument was acknowledged before me
The forgoing instru
t was acknowledged before me
this day of 200?8 by
this day of
20� by
I)qvI" VA I Ai G,
Y. �✓
(Name of person ac ledgin )
(Name f person no
ledging )
(Signature Notary lic- State of orida)
Si nat re of Nota
lid- State_ f Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
PAY�y
Produced spa o SHERRI FEHLMAN
e� �,
Produced
�.:____• SHERRIFEHL MAN
Commission # GG 1871
-NA II
A.�;,
0
(cy, commis'sion # GG 187160
Nei "
Commission,No. 9 �&aal) Expires March 14, 20
rFarp22
Commission No.
yQ. �; � . �� •(S6a#.s Mar
ForF6o``
2s
I.' BOOM Thru&,dcgetNotary
B""W1W'V8 9-tN.
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