HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCiANNE[) Permit Number:
< <� gy RECEIVED
IrIL alga St Lucie Count
Building Permit Application FEB 12 2018
Planning and Development Services ST. Lucie S9N1'Ity, 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 d jopbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:'-7 34 4p� S � � KW 1 4. Q �vt
&S E -,-�>C) FT AC cDr
Property Tax ID #: 1 d--0-7— 4-.�i — PPAO C-�— I Lot No.
Site Plan Name:-,,0r_)re_rrk I.1) Block No.
Project Name: '_ cx--,e��r\
Setbacks Front Back: Right Side: Left Side:
OETAILED DESCRIPTION OF WORK:
P,n
1 S�Gt 11 t=� o l 1 c i-P CAo�1 S i K_ �- �u 5 L ,ne
g n -R no l c_cnne_C-+-
CONSTRUCTION INFORMATION:
ka
Additional work to a er orme under this permit -check app y:
�HVAC 10 Gas Tank []Gas Piping Shutters a Windows/Doors
_
Electric 0 Plumbing OSprinklerl El Generator El Roof Roof pitch
Total Sq. Ft of Construction: S�Ft.1 of First Floor:
Cost Construction:
of $ Utilities: u Sewer Septic Building Height:
OWNER/LESSEE: , .
CONTRACTOR:
Name �>' i(� ��/�-1 `
-s
Name
Address:
City: State:
Address: =d�5
City: I!' O_ State:
Zip Codc Li�ih� Fa 1 i -LD�O
Phone No� —� �--
Zip Code:J��t �+ Fax
E-Mail: 1 1 ) 101
Phone N� 3 -,544-0
E-Mail: • -� l-ei )ec nq I
��
Fill in a simple Title Holder on next page ( if differ
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�or
SUP+PLEMENTAL CONSTRUCTION ILIEN-LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
:'MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: I State:
City: State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not
Applicable BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: ' Phone: I
OWNER/,CONTRACTOR AFFIDVIT: Application
I certify that no work or installation has commenced
is hereby made to obtain a permit to do the work and installation as indicated.
prior to the issuance of a permit.
St. Lucie County makes no representation that
which is in conflict with any applicable Home
structure. Please consult with your Home Ow
is granting a permit will authorize the permit holder to build the subject structure
Owners Association rules, bylaws or and covenants that may restrict or prohibit such
iers Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested
in accordance with the approved plans, the Florida
permit, I do hereby agree that I will, in all respects, perform the work
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
improvements to your property. A Notice
before the first inspection. If you intend
commencingwork or recordingour Notice
Record a Notice of Commencement may result in your paying twice for
of Commencement must be recorded and posted on the jobsite
to obtain financing, consult with lender or an attorney before
of Commencement.
e 6rAd
Signature o&10, n Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIaQ_L!
STATE OF FLORIDi� I LJ [-��
�� 4
COUNTY OF '✓
COUNTY OF t1J
The o it str sel nowledge fore me
this f day o 0 1 y t
0 ju�,� ( RA
The fgrilih' �trument a c <n wledgl before me
/ s I �" of 20� Y
) VV �
Name of p s making atement I
Pe on Ily Known ' 1 OR Produced Identification
Type of Identificati n
Produced
Name of person making statement
Personally Known OR Produced Identification
Type of Identification e
Produced
(Sig at re of Notary$jyQ - Stat IiA6t�i Q® ON
?° ""'• ° Commission#GG1k6192
Commission No. * * C.Arpq
Bov*anwB4AFt i
(Sign °tu a of Notary Public- State of Florida )
'07 P% JENNIFERCORSON
Commission GG156 ' 19tSeal)
. oe Explres October 30, 2021
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SUPERVISOR
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Rev. 8/2/17