HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE CO LETED FOR APPLICATION TO BE ACCEPTE 1
Date:T! Lz 0 1 7 Permit Number: -
j' y
OCT
Building Permit Application'-,,;'.
2017
PERMIT-TING
Planning and Development Services
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone- (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR:
PR ,,, INPROVEMEi T LCICATIC?N. `
j
Address: 2 FL E1-c .TWOoD L Al
Legal Description: P4jec F_L :L d -3 $O(b - 0 0 0 7-O ® CP _ 7
OR/E�!=(JOGD ftTAv02 -SECTrdn1lJA;C -.40T -7 (,4S-AC) (a/R 3b-77-17/4 ; 3g5(3
P 1operty Tax ID#: - q 9S� J Lot No. rl
Site Plan Name: _FC.1FEN Block No.
Project Name: 11/ TLE1-C-/J C%48/fuETS 4 72 [-E
SI tbacks Front Back: Right Side: Left Side:
DETAILED DE CIII,PTIpN;,t3F WORK
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CONSTRUCTION IN`FORIVIATION
Additionalwork to be performed J under this permit-check all that apply:
_Mechanical _GaasssTTank :_as Piping Shutters _Windows/Doors
tl�lectric _L.__ fumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Constructio : Sq. Ft. of First Floor:
Cost of Construction: a Utilities: _Sewer _Septic Building Height:
DOWNER/LESSEE :> CCtNTRACTOR
Name Lr�'�0�2 D O t-✓EAJ-4 Name;...:,
Address: LA Cbmpariy:
City: CORT - Pf EoeCE State: Address: - t;
Zip Code: 3CN g2 Fax: City: State:
Phone No. `32 - 5-8�— 7 9 9-7 Zip Coder Fax:
E-Mail: k.,;oDDP6e_K6,e.4LJW (a_� 6w-.c i' 1 ,60 Phone No
.Fill in fee simple Title Holder on next. page(if different' E-jMail
from the Owner listed above) State or County License
i
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPFLEMENTAI.CONSTRUCI"110N,I:tEN LAW tN,FfJRMATIU.N.
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 recor in r otice of Commencement.
Signature I
O ner/Lessee/Contractor s Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 3' day of OCA 20n by this day of 20_ by
(Name of pe acknowledging) (Name of person acknowledging)
it
.(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. ..""""��. L § TA INGRW Commission No. (Seal)
Notary�ublic-State of Florida
. My Comm.Expires Dec 20.2018
=N� = COMMISS101 i
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