HomeMy WebLinkAboutBuilding Permit Application TALL APPLICAB.L INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �^q
Date: 10/L/ /7 Permit Number: RECEVED
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Building Permit Application OCT U 4 2017'
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie Coun , FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Siding
PROPOSED;IMPROVEMENT;LOCATION. .
Address: % Q_3 rn P_o PM . 0,r
Legal Description: T'QA-� c, tS — GSe — 1) (3 Q S C
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Property Tax ID#: i3 SGp —CCi 1 Z -QGO '` 3 Lot No.
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Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR-IPTION'OFWORK _
gemave �►_ (1 s; rw5 4a",, r•od q C..fj r lace wi- -4 «c�.�;
SbLir�s
CONSTRUCTION INFORMATION
rtiona wor to e e orme undert ispermit—c ec,a apply:
11HVAC 0 Gas Tank Gas Piping Shutters Windows Doors
❑ _ a
Electric 0 Plumbing Sprinklers Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ �7&C, 0 0 Utilities:Sewer❑ Building Height:
—Septicg g
OWNER/LESSEE r• ;CONTRACTOR:
Name V\0 W. S Name: t'a
Address:
603 /°abler P)hCA Or- Company: �Lclnws` �cv�c�f i(4ZQA . IA(
Cit P.
y: � �.e State:�L Address: - �1 �.�o.� I,�j y q t►
Zi Code: 3Y'q,�/ Fax: city: d' T P \ !/ v / l�n-�. State: �.
Phone No._ (77Z 1 Y�7 D Z W, Zip Code: 3YW Fax:C772),vo5, 01&6
E-Mail: Strr+ra\.4 °` MwiL CaM, Phone No. -772_) G7C, 0(16S
Fill in fee simple Title Holder on next page(if different E-Mail: ri S LtalnG C(� zov /1 C
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION.LIEN;LAW_INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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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.
1 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 wo&eoVfecording your Notice of Commencement.
Si at re of Owner/Lessee/Contractor as Agent for Owner Signa�of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru nt as acknowledged before me The forgoing instru nt was acknowledged before me
thi � day of 20n by this day of 20ja by
Name of person ma ing stat nt Name of person makin-g-stfjement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identi ication Type of Identification�, al
Produced Produced(Signature of Notary Public-State Florida) (Signature of Notary Public-SPate of Florida)
Commission No. (Seal) Commission No. (Seal)
RY„ LASHAHNA INGRAM
A :•��S Lei,;. Nntary Publir.
�. ..',,;...li,, M1 LASHAH _My Comm.Expire Dec 20,2016
REVIEWS FRRI)lT;�a Z,QNI�liblic PLANS VEGEtA =SEAC� � �n #FO
COtJNTE ) �.Expies
.u REVIEW REIE , f °•' BUMIAWAghNatinallgk %W.
DATE
RECEIVED �' gnnde ^uph .'ional Notary Assn.
DATE
COMPLETED
Rev.8/2/17