HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0 ' 0
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C", Permit Number:ASO
RECEIVED
Building Permit Application JAN 3 12018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462- 1578
PERMIT APPLICATION FOR: G
Address, '(-,4-U
Legal Description:
Property Tax ID #:
Site Plan Name( '
JiVEMENf LOCATION:"
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Commercial Residential —
--l-ne ReSeNe-, I
Project Name: (_�)(-U I !L__ 7_TQ_2 7-1
Setbacks Front_ Back: Right Side: Left Side:
DETAILED nr:r, PTI
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CONSTRUCTION INFORMATION:
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A . ddific i a . I , worKtobe Ji_FrT6-r-m-e-d_ —under this permit:d E11:1: z 3 1-1 Y:
E1HVAC LJ Gas Tank E]Gas Piping Shutters E]Windows/Doors
1$lectric E]Plumbing OSprinklers El . Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: $ �� Util,ities. SewerE]Septic Building Height:
V
OWNER/LESSEE- CONTRACTORf`
Name-Ven Name:
Address: eAQ22 2 rdt- Company:
City: P t-1;'t a t Pf Address:
Zip Co e- Fax: ity: &a' State, —
Zip Code: W Fax: - 0—
Phone
E-Mail: neNo. 0
I�J -
Fill in e simple Title Holder on next page( if different E-Mail:WAi L(--2L)
from the Owner listed above) state or ounty License: G6J 91c� C Co��
Lot No.
Block No. —
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:. Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: State: I
Zip: Phone I
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ; , — Not Applicable I
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone: I
I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereb 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 a�'d 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, walls, signs, scree 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
commencing work or ec in o Notice of Commencement.
Signat a of 0 er Lessee ontractor as Agent for Owner
Signature o ontract License Holder
STATE OF FLORIDA r ,
COUNTY OF
STATE OF FLO"'
COUNTY OF �}
strum w acknowledg efore me
Th May'
this day bf t� 1 20 by
The f i i trument w s a <nowledgecipfore me
this
20 by
Name of er on making statement
Personally Known OR Produced
Name of kerson making statement
personally
Identification
Known X OR Produced Identification
Type of Ident'fi atio \ 1 .
11�v`+ '
Type of IdRML-)
'Produced 11 �C nO�J,�
4Prodce'
(Sign ture of Nota ublic- St of Florida)
JENNIFER CORSON
Notary Publ' - State ofF orida )%e4
ore
ommission NQ. . C0MMs 0n#GGf
t�pY JENNIFER CORSON
Commission*N9
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ExpOo
Pocb30,2021
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!eal)EpiresOcober30,2021
OF FLo
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DATE
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DATE
COMPLETED
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lev. 8/2/17