HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ' 1 c
Date: l • ?)I. i Permit Number: `s I - 7 J
O._ BY
Of 6
St Lucie County RECEIVED
Building pp Permit A licatio
Planning and Development Services JAN 34 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 S1; t--u5ie County, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residerntia --)Ky
'
PERMIT APPLICATION FOR:
PROPOSED I.NPROVEMENT LO;CATION.,
Address: �4101
Legal Description:
Q.
U
Property Tax ID #: '
Site Plan Name:
Project Name:
Setbacks Front Back: _
Right Side: I U Left Side:
CON5TRUCTINFORMATIO,N•
�. ..
AAA
itiona ^rLe to hn per orme , "nrinr this permit — c ecL a t at a
_Mechanical _ Gas Tank _ Gas
_ Electric _ Plumbing _ Spri
Total Sq. Ft of Constructing:
Cost of Construction: $A �.3oZo
PP Y
Piping _ Shutters
nklers _ Generator
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Lot No. l
Block No. -I
Windows/Doors.'
Roof Pitch
Building Height:
Owl NER/LESS,EE:
...._
CONTRACTOR:'
. _NT
Name J
t' r
Name.
Company:
Address: �� C v
City: `� �� v
State:
Address:
Zip Code: �JV Faax:
r 3 t -1 6
City: State:
Phone No.
Zip Code: Fax:
I�
E-Mail: Mr 54 r04P rL M
6--AIsoc-44h . hef
Phone No
Fill in fee simple Title Holder on
next page ( if different
E-Mail
from the Owner liste" bove)
State or County License
ss ,Pros
7 a• •CQb3g
If value of construction is 2500•or more, a RECORDED Notice of Commencement is required.
--z
SU.PPLENIENTAL-MTRUCTION MIEN LAW INFORIVIAI'lON:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not'Applicable
Name
_
Name:
Address: I
Address:
City: Sta e: ' '
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I 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 gra ting 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 As ociation 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 the Florida Building Codes St. Lucie County Amendments.
approved plans, and
The following building permit applications are exemptlfrom undergoing a full concu'rrency 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
commen_qing work or recording our Notice of, Commencement.
Signature of Owner/ Lessee/Con ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF1.�1
COUNTY OF
The forgoing instru knent was acknowledgeytbefore me
The forgoing instrument was acknowledged before me
this day of 20J& by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida) I
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification !'
Personally Known OR Produced Identification
Type of Identific ' i
dentification
Produced KAREN S. NIE
Wbiuc
♦ > `B'
Commission # FF
1 15637
Commission No. -s ) My CommiisSion
''%'E�„�o": June 12. 201
x fires
ommi ion No. (Seal)
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