HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMVLETED FOR APPLICATIQNTO BE ACCEPTED -
Date: L Permit Number:
SCANNEED
BY
it
St Lucie County
Building Permit ApplicationL.� JAN 0 4 20"i0
Planning and Development Services
Building and Code Regulation Division L' 7.
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
<PROPOSED IMPRO�/E'MENT LOCATION
Address: (a r
Legal Description:
Property Tax ID #: y5k1'� 1�' �O�c'2— a �� — Lot No.
Site Plan Name: ff tnt , t jam__ Block No.
Project Name: 10>JC--S _e�
Setbacks Front Back: Right Side: Left Side:
)t IAI .tU:,UtbU,11 ' I°ItJIV U1-:_ WUKK
-�trr► - ;Nw-ft oktyrPv l �� {�,�� lugf
cr
Je_nG(v51e D\C F��c�da room
°CONSTRUCTLO.NINFORMATION'
Haamonai worK to ae errormea unaer tnis permit— cnecK ail tnat apply:
1 HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
® Electric 0 Plumbing OSprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: O� "�� S� S . Ft. of First Floor: 12�0.
Cost of Construction: $ <?-M K Utilities:cnSewer ElSeptic Building Height:
,OW.N;ER/LESSEE': CONTRACTOR
Name -X---LLNj -C
Address: (oaf &V"
City: J e�A s✓► g c� State: �-
Zip Code: 3 Y 9 5 7 Fax:
Phone No.
E-Mail: DokAlvlsc► oZe ygf1o"01 GOP1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: . _' I5-k l
Company:
Address:
City:
Zip Code:
Phone No.
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Fax:
State:
DESIGNE
Name:_
Address:
City: Q,
Zip: 3Y
NEE�_ Not Applicable
We_kc.4 4-c-le—
5 W IV, 1-r,lnore 15Zr Sadie. I I L(
,uc'_t State: FL
Phone 77A '7165' 914'1
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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 vour Notice of Commencement. ,I
Siga 6re of Owner/ Lessee/Contractor as Agent for Owner
Signat' of Contractor/License Holder
STATE OF FLORIDA E
STATE OF FLORID
'� LUur�i't�!
COUNTY OF S`'I' L c� C (, /' o v rd f-ti
COUNTY OF �_ UCl E
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day CCU« 201 � by
this �_L day of E�yn3C-ram , 20L by
of .
PEO Z 4 3 Li0iCPA2
P��? eLAP6i�2
Name of perso making statement
Name of person making statement
Personally Known V OR Produced Identification
Personally Known _j/OR Produced Identification
Type of Identification
Type of Identification
Produced
1
Produced
(signat4ge of Notary u
(Signatur o Notary P ` lic- St t of Florida
SUZANNE J GOUDREAU
y
`• `•= MY C hSION �FFf36325
Commission No.
�P
=" =, SU7JINNE 4_QQPDREAU
Commission No. _:. �.
F f 3 �-
'sa EXPIRES June 25, 2018
FI= f 3 6 3� S- . �.; +aY COMMISSIONFFt36325
I�z131"153 FleridallotaryService.com
`''.'Eorti EXPIRES June 25, 2018
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tev. 8/2/17