HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTTED
Date: 1�' �� 00 8I3nl feermit Number:
-_J Inn , _ .� RECEIVED
Building Permit Application JAN 3 0 2018
Planning and Development Services T. LUde County, Permitting
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: To Select from dropbox, click arrow at the end of line 4Lg91n-P_
PROPOSED IMPROVEMENT LOCATION_
Address: 5
Legal Description: f dIQ.nRiVQ✓6laks (,lyi QR 6(L-_1 1, 'Lo+ I "1
PropertyTax ID #: Lot NoA L7
Site Plan Name: Block No. 749
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
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Right Side
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Left Side: Wo
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I
I CONSTRUCTION INFORMATION: III
Aaaitionai worK to oe errormea unaer tnis permit - cnecK aii apply:
1]HVAC 0 Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric Plumbing OSprinklers 1:1Generator2oof
Total Sq, Ft of Construction: �GS3 S . Ft. of First Floor: a�3Y
Cost of Construction: $ LRM:J co Utilities:Sewer Septic Building Height: IL
OWNER/LESSEE:
CONTRACTOR:
Name e5-Ee ar
Name: ,
Company:
Addre 5400 '� `H e
City: A7_I _ <X-f l..t ct". b State: _q_
Zip Code: )gL790 _ Fax:
Phone No. ffo 10�
Address: 0541
City: State: c—
Zip Code: �JL{ % Fax: "77a 7_77/0�
Phone No. �!a
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: CJ Cco( r_. o
State or County Li ense:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�sUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
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 vour Notice of Commencement.
s
_ Signature o Own / L 'ssee/Agent SiErnafure of on r for/License Holder
STATE OF FLORIDA "'�" STATE OF FLORIDA
COUNTY OF /T/[(Jl-t4i4 COUNTY OF ;U&r %fn
The forgoing instrument was acknowledged before me
this '-Q day of � 10-hUa 20 _r5by
e
(Name of person acknowledging
0 0 0, 22��L
(Signat re of Notary Public- St to CO
orida )
Personally Known OR Produced Identi ication
Type of Identification Produced-[�
Commission No. 66 a 3 (Seal)
The forgoing instrume t was acknowledged before me
thisZoday of 20 aby
P15
(Name of p rson acknowledging)
(Signagre of Notary Public- StatgPo"lo�i7a )
Personally Known OR'Produced Identification
Type of Identification Produced
Commission No. Q (Seal)
MY COMMISSION # GG91863 r� nL"""
MY COMMISSMa 1� 2021
Revised 07/1 P EXPIRES: May 17, 2021 0�< gXp�t y
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