HomeMy WebLinkAboutBuilding Permit AffidavitOCT 2 0 2017
Building Permit Applic rmIpng Dept. 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:
PRQPOD )NPhOVEMENT LQCA0'1'
S a
Address: '2=- D (,u A-L,tZ(epr a >5 L rt—c- 3 acis _
Legal Description: We(& 911_v lC_ w j or y'L4-
Property Tax ID #: S W. ,. 671 S' [ 2 Z-"1 jr9 - ' Lot No.
Site Plan Name:
Project Name: (2;fia�nti�°g
Setbacks Front Back: Right Side: Left Side:
f .�.. ��.
_Mechanical
_ Electric
rtormed unc
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction: g i
Cost of Construction: $ ` ,7'zS--'
Nam
—Gas Piping
_ Sprinklers
all that apply:
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Block No.
_ Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height: I g
Address: Ltya SC-7 <,E �ru-,,-kvvk,i�-T ,a�be�
City: -P5L State: V::--L..
Zip Code: 3LkgR 3 Fax:
Phone No. -n-L 21 S' )-'7(&
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company:
Address:
City: ru y(>u-_ ,cg— State:_
Zip Code:Fax:
Phone No '7 7 Z -Z (lfv —eD` -7
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of commencement is required.
7�,
DESIGNER/ENGINEER: _ Not Applicable
Name:'c.'Nr\1�✓'Ci1LUuLCJ
Address_gO(o � •
City: ?c' State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: '
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:"'
Not Applicable
BONDING
Name:
Name:
Address:
Address: _
City:
City:
Zip: Phone:
Zip:
MPANY: Not Applicable
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 dIeed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that�l 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
commenciriRmor_k-or-mcordinR your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Si re oflcontrac or/License Holder
n
STATE OF FLORIDA 1 n �,�
STATE OF FLORIDA
OF
COUNTY OF vim,~�
COUNTY
The forgoing instrument was acknowledge before me
The fo oing instrument was acknowledge efore me
n��
this o� Camay of 20 ey
this ay of 20l y
P n La,�:�nc� uct
Name of person making statement.
Name of person making statement.
ersonally Known ' OR Produced Identification
P rsonally Known OR Produced Identification
entification
of
Produced r
_ I
Produced
�
(Signat q, y Publics ®>* OfA frida
(Signature of Not r Pu to of Florida )
��`:�`� Y Pu Notary Pub11g
Commission No. 7_11�/*"R�F(Seal) •;�
F ' My irAfflfflExpj�rgs MaY ' �
• HUFF
do- i Assn. f'
` r State of Florida
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATI
'SEA.TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
I REVIEW
REVIEW' ✓`
ssn. '
DATE
RECEIVED
DATE
COMPLETED
Kev. K/L/ii