HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' Permit Number: 0
SCAN ED
BY RECEIVED
at Lu ie c®Uvity
• � "FEB 12 2018
- Building Permit Application
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 Commercial Residential
PERMIT APPLICATION FOR:
j0 Zr' obi
PR0005E0 INPRQVEMENT�LOCATION., Y
Address:
Legal Descripti
/nE. z 20FA..3q
Property Tax ID #: JA 33 v 10i s 09 A -Oc o- to Lot No. 'i
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
t
CC►NSTRUCTION INFORMATION `
Additional work to be per orme unclerthIS permit-, Check all thatAShutters
ply*
�
_Mechanical _ Gas Tank _ Gas Piping _ _ Windows/ oors
_ electric "' Plumbing Sprinklers.,..�I..'! :.Generators':.,. Roof J Pitch
el
�TotahSq:' Ft'of'Cohstruttion:'. �� Sg:, Ft..of First:Floor
. . �, s.. ' ..
Cost of :Construction° $ ;LS/33� :Ob utillties:' ' F AS
eptic Building Height:
C}WNER%LESSEE:. ' . „'.. '
CONTRACTOR: .
Name
Name:' it ''
Address: ,5"i
Company-BA&AMS
City: ` State:
Address: 7O `
City: SEC State
Zip Code-U L153 Fax:
Phone No. ,�:t7 —47.5" 37Z8
Zip Code:`. Fax:
Phone No %%` - LS
E-Mail:
Fill in fee simple Title Holder on next page ( if different.
E-Mail
from the Owner listed above)
State or County License �3 Z
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL
CONSTRUCTlC3N L1E(I LAW CNFQRI�lIATtON
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g �q
DESIGNER/ENGINEER:"- _ Noi`Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Nalme:
Address:'-' I
Address:
City: State:
City:. State:
Zip: Phone
I
Zip: Phone:
- •
FEE -SIMPLE TITLE HOLDER: _ Not APlplicable BONDING COMPANY: Not Applicable
Name: I Name:
Address: I Address: INI
City: I City:
Zip: Phone: I Zip: Phone:
I
OWNER/ CONTRACTOR AFFIDVIT: Applicat}on is 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 gl anting a permit will authorize the permit holder to build the subject structure
is in
which 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 IAssociation 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 Ito obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
114 I
Signature Owner/ Lessee ontractor as Ag t for Owner
Signatur of -Contra-7older
STATE OF FLORIDAc� I I
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument knowledged before
The forgoing instrument before
was a me
was acknowledged me
this day of 201R by
this L day of 20_&by
�.foil &Iwt
Na a of now ledging)
(Name of knowledging
person ck
I
+�i%�-,,, Kimberlyn M. Ga
person )
o �1�,,, Kfmberlyn M. Ga
Commission # GG1
2 °t: �:
_ ;�_ Commission t GG17M
d
( ignature of Notary Public- State 6f�?1o1 �`) Bonded thru Aaron
+++++�
p nature of Notary Public- Stat(i, ' ,) Ua1y , 2
'��,+►+++� Bonded Ift Aaron
Personally Knowny OR Produced lcl ntification
No
Personally Known 7� OR Produced Identification
Type of Identification
Type of Ideptification
Produced
Produced P
Commission No.-6&11,,51PZ7 (Seal)
I
Commission No.6617sd/ZZ (Seal)
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