HomeMy WebLinkAboutBUILDING PERMIT APPLICATION!
1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater 2 Di. ���> SCANNEDPermit Number:
w
BY
St Lucie County
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
Address:
RECEIVED
JAN 2 5 2018
ST. Wcie County, PP
rmitting
Commercial Residential
Legal Description: _` t'V' , �iS�{Ei�i� CrA(4- 060 - Ad2 114 t I, I S D C
Property Tax ID #: 3 0 ?-- - D-1 - (� 2.0®- (`)00 - { Lot No. go ¢Ltg
Site Plan Name: Block No.
Project,Name: G5!je.,A 712,EG«Je_Acc,.
Setbacks Front s Back: V1_5— Right Side: ).7 Left Side: 9—
!
A1,ew �s� i� f ��.I,� � I� _,!v ,g fa- -�� l y rz vd e�%,cL�
'r �`[ S Ulcrfi 1"Gtiv U/lGtGr ��rt -3rsocq s7u4i-G 4"- i�Dpul
i
Electric
D'PI umbing
Sprinklers
Total SO. Ft of Construction: 3 Z_60
Cost of Construction: $ � DD 6 • 0 Q
11
Shutters
Lam! Generator
Windows/D/oors
Roof
Roof pitch
Sq. Ft. of First FI : 3, �60
t
Utilities: _Sewer _Septic Building Height:
O:INNER�LESSEE�' t '
CUNTtACTC>R
E
.m..
Name. chQ.r(ZS !3en
Name: ..IQcA44et1% i;N, ��rL�a/rr►2cn�
Address: D t .
Company:c;`cen (gun
Address: (D I I '(�'v�b►crt el .,
�c4 rre,
City: `a F,3� 14- 9 e_rzai State: ,L-Z-
ua
Zip Code: 149 SZ Fax:
City:
Stater
Phone;No. _112 - y6.0 - 6. 110
Zip Code: 341 Fax:
Phone No. - 172-3:1r)r C95
E-Mail:
-7Q
ae) • ee3/y,
n E-Mail: 0P� e,a, 6 ",j dN wad. ae-i-
Fill in fee simple Title Holder on next page (if different
State or County License: C&G i
150 q 2 A 0
from the.Owner listed above)
if value; of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�SUP�LEMENTAL. CONSTRUCTION`LIFN LAW INFORMATION:
� •
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Applicable
Name: ( P'P..� rl �n'S
Sin LL G.�
Name:
_Not
Address: (2G � � �o o�e�_/��r.-.
Address:
City: i! Fd� - P; � r-��
State:
City:
State:
Zip: �u.�ADq Phone -'jz2-
�2$� l� 3 ro �{
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not
Applicable
BONDING COMPANY:
of Applicable
Name:
Name:
Address:
Address:
City: ��
city:
Zip: Phone:
Zip: Phone:
5
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 consi6ration 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
commencin work or recordingour..Notice of Commencement.
Rev. 8/;2/17
f;
i
Ow Commission
Signature of ontrac or/License Holder
Signature o Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE -OF FLORIDA
COUNTY OF J7 .
COUNTY OF S`�
The for oing instrument was acknowledged before me
is g
The f ing instrument was acknowledged.I�efore me
this %day of u. 201_ by '
thi� day off � 20 by
a son making statement
' a making statement
-person
ersonally Known OR Produced Identification
Personally Known OR Produced Identification
Type o I ication
YP
Produced
Produced
ij
(Signature of Notary , • - on a
• j=a�'""`��; ART?i R LEE CROSS
Signature of i a S
�a•-• THUR LE CROSS
Commission No. _•� .l•
a N1Y
=�_'139555