HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 6-19-17FI
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ` OAP • ��
Building Permit Application JUN 19
Planning and Development Services PERM'
Building and Code Regulation Division St. Lucie C a%, . L
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
W
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: �Sltiy�/L�
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _ 5nutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: _
Utilities: —Sewer Zeptic
_ winaows/uoors
Roof
Building Height:
OW'N7ER/L SSE
Name-.
Na
Address` L�
Corhpany:� "
UM.
M.
City: State:
Address: 5 5 ilL+'Y
Zip Code: Fax:
City: State:
Phone No.
Zip Code: D Fax:
E-Mail: !� @ / 4(� etd
one No Z '
"Fill in fee simple Title Holder on next page ( if different
E-Mail �60 92(A-Jla?W �ss.✓�ri
from the Owner listed above)
9Er County License c 6e_ Wa4;!3 .
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
ii!. ' iI
d
SU! '`,HPMERNTAL CO'NSME 1 TIOO N LIEN LA INFO MATIO'N.
DESIGNER/ENGINEER: ' Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: q
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: uNot Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: N
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
q
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 an9covenants 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 pr A otice of Commencement must be recorded and posted on the jobsite
before t st inspectI n. If you�,Jnd toobtain financing, consult with lender or an attor efore
om ncin ork or re ordin Notice of Commencement.
I.
Signature Le s e/Contractor as Agent for Owner
Owner
Signature o o Li!nHolder
-� :•
STAT I f
ft
STATE OF F
COUNTY OFF asp
COUNTY OF N
The forgoi• instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this a of n - 20_M by
this k_o day of 7 u. , 20]1 by
(Name o p r on acknowledging)
(Name of rson acknowledging )
(Signat a of Notary Public- State of Florida)
(Signatu a of Notary Public- State of Florida )
Personally Known L0"___OR Produced, Identification
Personally Known Ll---'OR Produced Identification
Type of Identification
Type of Identification
Produced a� ��. OCARROLL
Produced ¢ vro8'- GCARIiOLL
MY COMMISSION# FF 182502
* * MY COMMISSION # FF 182502
Commission No. EO Demmber10,2018
Commission No. (LWA' SsDewmber10,20m
rFOF F�Bonded Thru Budget Notary Services
4"eOF F%.U�O Bondedl'hru Budget Notary Services
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SUPERVISOR
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REVIEW
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DATE
RECEIVED,
DATE
COMPLETED
ev.