HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r�
Date: Permit Number: 1 l 55-3
- i Building Permit Application DEC a '' 2017
*
Planning and Development Services St PERiWl7TlNG
Building and Code Regulation Division Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential #
PERMIT APPLICATION FOR:
PROPasED, INPROVEMENT LOPCATION.. T
Address: &'� / 7 X t_f" /G nn T -rei o e Ale.
Legal Description: &Ye -I've &a & ZM - /��.t e Zb f / _?
33
Property ax ID #: 33 XT/- Ze-, 0 2 i�20e_-9 - 6� Lot No. f
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: 7F Right Side:.6 _ Left Side: X/
DETAILED DESCRIPTION OFW(3RK:
b O
r
CONSTRUCTION INFORMATION r
Add
itiona wor c to ape orme , under this permit- cheCK all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
?l Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ,4<e0
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Building Height:
fJWNER/LESSEE:
CONTRACTOR;
Name , ,0se 42X 'BSc
Name:
Address ate
✓I �c.
Company:
City: oaf l �S�• �a r
State: �,
Address:
Zip Code: Og.. !f 4 Fax:
City: State:
Phone No� .3'
l
;fitp Code: Fax:
E-Mail: �' /(0
Phone No
Fill in fee simple Title Holder on next
age ( if different
E-Mail
from the Owner listed above)
State or County License '
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
�
DESIGNERANGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: 0
Name:
Address:
Address:
City: 0State: ®
City: State:*
Zip: S 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 OwnersAssociation 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.
Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S1t :_
COUNTY OF
The forgoing instru ent was acknowledged before me
The forgoing instrument was acknowledged before me
this &X day of ss 20n by
this day of 20_ by
Name of per n making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Anavo-D113, �, ___`1
(Signature of Notary Public- Stat f Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
LASHAHNAINGRAM
REVIEWS
FROI T.(,a ,�.?
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DATE
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