HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONE
All APPLICABLE INFO MUST BE COMPLETEIFFOR APPLICATION TO BE ACCEPTED
Date: \QA vk 1 �1 Permit Number: 11 �k' o� 5G
Building Permit Application
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: R a of
Address
Legal Description:
"1 /.1Z,
Property Tax ID #: �� 7a) b [J�C (2C2/ -'f-/ Lot No./fZ
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ditionai worK to be
_Mechanical
permit - cnecK a
_ Gas Tank —Gas Piping
a
_ Shutters
Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor; ����
Cost of Construction: $ Utilities: —Sewer —Septic'
Building Height:
Name LL G
Address: 236 % CAG1-,Zfl&�A-' l -J)
City: aEIZ CC- State:
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: R-IUVKLU
Compan L 01d Jq- W
Address:
City: ° -.7 State:
Zip Code: llx& '!;�- Fax:
Phone No��`�
E-Mail�ffll%��•-r7�f/%2//,L.T��e%
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMP NY: _ 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: I Zip: Phone:
I
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 firs inspection. If you inte to obtain financing, consult with lender or an attorney before
N1ce
comm cin ork or reco din o of Commencement.
I
Sig e o Owne / Le ee/Contracto as Agent for Owner
Signat f ontractor/Licen a er
ST OF FLORIDA
COUNTY OF ' S . U-3C:%
STA , OF FLORI A
COUNTY OF
I
The forgoing instr ment was acknowledged before me
The fo going instr ent was acknowledged before me
this A- day of t L 20 by
this day of 4) c , 20j- by
L \ � mo d► �, e 4.,
(Name of person acknowledging)
(Name of per on acknowledging) _
•
(Signature of Notary P lic- State of Florida)
(Signature of Notary Public=:State of Florida )
Personally Known OR Produced Identificaat'
Personally Known OR Produced Identification
Type of Identification DE IEGIVENS
IL •�YPUO••,
Type of Identification
Produced
Produced
- MMISSION # GG 012023
�
EXPIRES: December 16, 2.020
Commission No. = S1B ryPubliclindetwriter
Bonded }e
_,. iP yoga••, DLANNA MARIE GIVEN i
Commission No. YCOMMISSI��I �jD22023
j{,,
EXPIRES: Dec m er 2020
BondedThruNotaryPublicUndemilers
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