HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
8CANNEb
BY RECEIVED
St Lu Cie: G901*11/1
Building Permit Applica ion JAN 2 3 2018
Planning and Development Services ST. Lucie County, Permi!
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:S .
PRbPCiSED !N_PRO1l MENT L,tJCATION '
Address: CEO w O O 10
Legal Description:
Property Tax ID#: 1�13� Spa-�6a��c�tSO' Lot No._
Site Plan Name: Block No.
Proiect Name:'
Setbacks Front Back: Right Side: Left Side:
aitionai worK to oe perrormea unaer
_Mechanical . Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
s permit — check all that apply:
Gas Piping _ Shutters _ Windows/Doors
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name k I 0< -" (. 6 N _
Address: U 4OO
City: State:
Zip Code: Fax:
Phone No. c, L
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: e 10 - %
Company: Pit— 0 _w C"Oq . 1
Address:
City: Q L State:
Zip Code: § -Z, G Fax:
Phone No cj r W 6 % 0 "
E-Mail e._,) L_i�.�Tr� f:-'OA
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
r1
SUPPLENtENT, CENSTRUCTIC}N 1 IENSLAW INFC�RMATION.� a
y
Applicable
DESIGNER ENGINEER: Not
/ — pP MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone � Zip: Phone:
I
FEE SIMPLE,TITLE,HOLDER: , _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I 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, wails, signs, screen rooms and accessoryuses 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.
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NNO'e�pr_r )J
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Signature of wner Lessee/Contracto Age
't for w Yer ---
Signatur of Contractor/ icense Ider
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF �-�' • �-U� ��
The forgoing instrument was acknowledged before
�'A
me
The forgoing instrument was acknowledge before me
a3 �'►
thisW. day of f 20AI by
this day of 4 201t by
�•1�,�c;ctle. Lew°,.5
�le.�Qr;ck Le,w�s
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notaryublic- State of Florida)
(Signature of Not&y Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica n
--- �
Type of Identification
Produced 4Jp'°°., DEANNAMA~ZIE
'�°° �•�'�MY COMMISSION
GIVENS
# GG 012023
Produced 1—, .••^°°°... -
:• °_.� NNA MARIE GIVENS
*'
Commission No. EXPIR�
BondedT o
member 16, 2020
IPublicUndenvitere
_ MY COMMIS ION �t GG U22023
Commission No. '
�o: EXP camber 16, 2020
•%��'oF
EOFF�o,.
F�,•' Bonded Thru Notary Public Underwriter,
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Rev. 7/2014