HomeMy WebLinkAboutBuilding Permit Application `101 . 0LS5'
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICA7ION TO BE ACCEPTED M
Date: Permit Number: "',
P
JUL 1 0 2017
PERMITTING
Building Permit Application St. Lucie county, FL
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description:
Property Tax ID#• 0 - 'Q c� 0- 0 Lot No.
Site Plan Name: i � Block No.
Project Name: l�
Setbacks Front Back: Right Side: Left Side:
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Itlona wor to (e�e orme un er t Is permit-check all app y:
❑HVAC L_1 Gas Tank ❑Gas ng _Shutters a Windows/Doors
�E{ectric 0 Plumbing Sprinklers 0 Generator R Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ AVkQV. Utilities: ^SewerSeptic Building Height:
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Name Name:
Address: vlow Company:,_SW-,_,;,,. C� dv_- �e
City; �e- lee State: Address:
Zip Code. .3 If 19,T- Fax: City: W 5 ate•
Phone No. atS -88'( 14 t `t Zip Code: ci 17 Fax:
E-Mail: Phone No. 17 —J2 3 —
Fill in fee simple Title Holder on next page(if different E-Mail: cS�s�,�r cG c�T ct7 Gay.
from the Owner listed above) State or County License: sC o®ae�48'l
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Nam
e:
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:
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.
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Signature of Owner/Les—seOC6ntractor aif Agent for Owner Signature of Contra en older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF M�k��
The forgoing instrument was acknowledged before me The forgoing instrum nt was acknowledged before me
this day of _ 20 r1 by this day of 20 11 by
(Name of person acknowledging) (Name of person acknowledging)
o� I �AiA L I A //�-/
(Signature of Notary Public-Stat of Florida) Signature of Nota' Public-State of Florida) s /
Personally Known OR.Produced Identification Personally Known OR Pr_gdu d Identification
Type of Identification Produced T-— .(,)I Ona Type of Identification Produced wy Commission No.
y''(� �Ij'�HNA INGRAM 'yt Commission No.�ogLAk�y (Seal)
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Notary Public.state of Flo
cu . p i >"/ my Comm •.Fx rida
'. OFF?""" C ommission.FF 177299 •' = NOWYPubllc-stateof Flo14 rida
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Revised 47/15/201 _` -_�_d through National Notar 'L G °sal2
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