HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i 1 `b Permit Number:
RECEIVED.
Building Permit Appl'catim, 112018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permltting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED I,NPROUEMENT LQ,. AATIaN_ .
Address:,
Legal Description: _1t�VAJU '0�, ewe lE-�JW i5-75 !�(20
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
CON5TRUCTION 1NORIVIATION
Additions work to a pertormed under this permit - ctieck'-all tat app ' .
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 17,00 Sq. Ft. of First Floor:
Cost of Construction: $ 4 -`0 Utilities: —Sewer _Septic Building Height:
tJ1NNER/LESSEE
s _v �d
CONTRACTOR:
Name Lt,.j t7A 12e-\#,i 3DA V l .S
Name. ,6-r ay%y'/ 6Aar r�6-(lq"�d
Company: (-L�v`c�� 4 �vs���-WF� Ll CJ
Address: 3 `J l
Address: aZ 3 �5cr �L
City: th el Stater
Zip Code: 3gct 92 Fax:
Phone No. `% 7 2 �1 3.S i�
City: .F---t Q�r. � State:,
Zip Code: 72 LLcUrZ Fax:
Phone No -7 7 7, Z 1 t, —8-0 T7
E-Mail:
Fill in fee simple Title Holder on next. page ( if different
from the Owner listed above)
E-Mail
State or County License 02
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I\
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SUPPLEMENTAL CONSTRUCTIaN LI N IN AT
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not,Applicable
Name: Atirc+- s t e5Z;C, tiS 1, r::� �" e-,
Name:
Address: D- Lam, Alca emu% I
Address:
City: v:�r- PCOZZ4—�-' Stater
City: State:
Zip: 3Ltq D Phone
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:
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OWNER/ CONTRACTOR AFFIDVIT: Applicationlis 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 rules, bylaws or and covenants that
Association 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 BuilIding 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 alNotice of Commencement may res "your paying twice for
improvements to our operty. A Notice of Commencement must be re d and posted on the jobsite
before the first ' ctio . If you intend to obtain financing, consult wi nder r an attorney before
commenci or re rdin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIQA
COUNTY OF S . 1- vr-\R-
STATE OF FLORIDA ,
COUNTY OF
The forgoing instrment was acknowledge before me
The forgoing instrument was acknowledge before me
�
this day of yy� 20 by
this day of �d+ 4 20 by
qs-k C5V,
(Name of person acknowledging) J
(Name of person acknowledging )
(Signature of Notary P lic- State of Florida)
(Signature of NotaryPublic- State of Florida )
Personally Known OR Produced Identification I
Personally Kno _
` 11h N RIEGIVENS t
Type of Identification
YP
Type of Identific - MY COMMISSION # GG 022023
Produced _ NA MARIE GIVENS
Produced ryP1RPq-D'2cQ bet 16, 2020
-
coed MY comMISSION # GG 022023
Commission No. 1�-� .as EXPli�gia��r�mberls,2ozo
% q 2;� '' Bonded Thru Notary Public Underwriters
Commission No.
-7 Bonded Thru Notary Public Underwrite
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Rev. 7/2014