HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \�U'�� Permit Number: an i- n i
RECEIVED
Building Permit Application JAN 3 0 2018
Planning and Development Services
Building and Code Regulation Division ST. Susie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line +�_ V/CF._
PROPOSED IMPROVEMENT LOCATION: VCLi t'r
Address: Gf15 1 /V�
Legal Description: S l�l(.u"1(,i V1 c�iOki C(r(_J'ICSv-o -V�
in C&Vn
Property Tax ID #: 'q560 -601- 0_29I - 6W Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
r-cinf ak riaf) C-Cob - (kis4a�- seW
o v'd Ver lct I-Qw Fi r W-0--0J POOP
CONSTRUCTION INFORMATION:
Additional work to a er orme under t is permit - c ec a app y:
r-I
0HVAC Gas Tank Gas Piping _Shutters Windows/Doors
11
Electric Plumbing HSprinklers GeneratorJ�15oof 3 1`Z..-,
Total Sq. Ft of Construction: 10 (-7 S . Ft. of First Floor: /0 1-7
Cost of Construction: $ 77cxl� Utilities: Sewer Septic Building Height: I
OWNER/LESSEE:
CONTRACTOR:.
Name
Name: S
Address: 11
Company:
f1C
City: State: Tr-_T_1
Zip Code: ��J�gtJ Fax:
Phone No. 02 I _ I LA`-, (_7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address:
City: L7�Il,r� `
Zip Code: ��%
Phone No.
State:i4 -.
Fax: 7%? �% 72(03
E-Mail:
rS . C614
State or County Li nse:
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:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 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, 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
commencing work or recording your Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA�� _��:�
COUNTY OF /�(,� Y't't
The forgoing instrum t was acknowledged b fore me
this day of 20 M y
e of person acknowledging
Notary Public- State of FI -r \ '
)wn I OR Prod tifiFation 7c
Type of Identification Prod
REBECCA RESTIFO
/',&'/ I �� s
Si nature of Con ra or/License o der
STATE OF FL RIDA
COUNTYOF L in
The for oing instrum nt was acknowledged before me
thisday Of il. n • 20 Jaby
(Name of_ erson acknowledging )
"D
(Signat re of Notary Public- Sta of lorida )
Personally Known OR Pro ced Identification
Type of Identification Produced
Commission No.U1&a1So3 (Seal)
�` PIRI S; May 17, 3021 I MY COMMISSION # ®@91l16j
Revised ],�ao' EXPIRRS; May
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