HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE
FOR APPLICATION TO BE ACCEPTC '
Date:
Permit Number: I' ) - m a_y
BY
st Lucie COW
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
RECEIVED
FEB 2 6 2018
rmitting Departm'
Residential y
St. Lucle County
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENTICICATION. "X
Address: TS q ( �
Legal Description: 1o
103
Property Tax ID #: 3 �-7 V 1 - V Q C � U 0 0 `-1 Lot No. '
Site Plan Name: r) I Block No.
Project Name: L(D C) ri
Setbacks Front ack: Right Side: Left Side:
DETAILED DESCRIPTION OF' WORK.. p ,
�c) I ax Foal �u �
Aaaitionai worK to De errormea unaer finis permit - ci
❑HVAC Gas Tank ❑Gas Piping
❑Electric Plumbing []Sprinklers
5�-
Total Sq. Ft of Construction:
Cost of Construction: $ a -a (_') c>
appiy:
_ Shutters ❑ Windows/Doors
❑ Generator ❑ Roof Roof pitch
S.Ft. of First Floor: _
Utilities: Sewer ❑ Septic
Building Height:
OWNER/LESSErE
CONTRACTOR:
Name V %� t
Name: P �u U
Address: ylg,r6d AAL.
Company Olt inn bine
City d Sta
Address: P
r _
Zip Code• (P Fax:
1.-
City: + LU State.
Phone 'No._� '_) r�
Zip Code: Fax:
E-Mail:
Phone No. ') _1 -a
Fill in fee simple Title Holder on next page (if different
E-Mail: i d w
from the Owner listed above)
State or County License: F <0 (D
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
SUPPLEMENTAL CONSTR61 0N:L[EN LAIN INFORMATION.
,. : ,. ,. ; r� ;
DESIGNER/ENGINEER: _ Not Applicable P le
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:
OWNER/ CONTRACTOR AFFIDVIT: Application 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 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 oLzecordine vour Notice of Commencement.
Q ) .
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ALS'4�N"�� -
Signature of Owner/ tegs'ee/Contracto"Alagent for Owner
Signature of Contractor/License Holder
STATE OF FLOR� - 3
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STATE OF FLORIDA-- L-u Lu
COUNTY OF U
COUNTY OF
The [q rgoing instrument s acknowled a before me
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The going instrument w s acknowledged efore me
day �= IP- 20 I by
this lb day of . 2� by
this of
Name of pers making statement
Name of peyysdn making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur sy QL1UGM5&L ExlarAn 111 U
(Signature of foary Public- State o Florid
•,••1�pV PV'..KARLEY MARIE GIESY-VARNEY
Commissi .o': Notary Public -State ofFI(Sbal)
C r rcki �.�,JVoKARLEYMARIEGIESYVARNEY (Seal)
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-; My Comm, Expires May 1, 2021
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• Commission y GG 099801
°F BondedtMou§hhaGoralt.ctaryAssr.
P; MyComm, Expires May1,2021
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tev. 8/2/17