HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEP i cv
Date
SCANNED
Permit'Number: 40op `008F
St Lucie CountRECEMD
t - FEB 0 6 7018
_.M.. w...... ... Building Permit Application
Permitting
Planning and Development Services St. comey
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:
PROPfJSED liUPRC}1tEfvlENT.W.CATI
Address: IN CYnqCv-0( ((�ok r U- -erc-C Hk. : Ct5
Legal Description: La.� Pic U o ,� to
Property Tax ID #: ' lolk " (03 P6 - GOO? Lot No. -"-2 T
Site Plan Name: Block No. 3 3
Project Name:
Setbacks Front Back: Right Side: Left Side:
wo r
_Mechanical
e perrormea unaer finis permit — cnec
Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: d�
3 2. Sq
Cost of Construction: $ Utilities:
Nam
Address:
City: 'Et -(APr-c�eState: Kr_
Zip Code: 3` q 5 J Fax:
Phone No.
E-Mail: 5n601( 14A- C_l0— -'PWt • CCww
Fill in fee simple Title Holder on next page ( if different-
from the Owner listed above)
apply:
_ Shutters _ Windows/Doors
Generator _ Roof Pitch
Ft. of First Floor:
. Sewer _ Septic Building Height: _
Name:
Company:
Address:
City:
State:
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.
I�AW
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DESIGNER/ENGINEER:
_ Not Applicable . , MORTGAGE COMPANY: — Not Applicable
Name:
'Name: .
Address: car,+:°.Y
I .Address:.
City:
I State: j .)City'- State:
Zip: ,Q i '•-'Phone
I Zip: Phone:
FEE SIMPLE;.TITLETHOLDEIR: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:' I
Address:
City: I
City:
Zip: Phone:
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 ppermit holder to build the subject structure
which is in conflict with any applicable Horrie`Owners Association rdles, bylaws or an'd'.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 approve 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, swimmingi pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Youir 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.
Signature of wner/ Lessee/C
ntraffolas Agent for Owner
Signature -of Contractor/License Holder
STATE OF FLORIDA
S�IL.0
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The fo going instrumen was acknowledged
to reh
before me
The forgoing instrument was acknowledged before me
this day of
20JI by
this day of 20_ by
(Nam of persona nowledgi
g)
(Name of person acknowledging)
a
g at'ure of Not P lic- State
of Florida)
(Signature of Notary Public -State of Florida )
�.
Personally Known 011
Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. .��"��.
LA(SijI)IA INGRAM �"
Commission No. (Seal)
Notary Public - State of Florida
I •1 My Cow. Expires Dec 20, 2018;
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a CoMMIssion
# FF 177249
REVIEWS
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PLANS
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REVIEW-"
REVIEW
REVIEW
REVIE
DATE
RECEIVED
atkz�.�
DATE
COMPLETED
ke—v—.7/2014