HomeMy WebLinkAboutBUILDING PLAN APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO RE ACCEPTED
Date: A; 20 1 bb I Permit Number: NA d °�— (3 so i
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3
Phone: (772) 462-1553 Fax: (772)
�ANNED RECEIVED
BY
Cie County F P 8 d ®- Z018
uilding Permit Application , __
'.ucie County, Permltt(ng
-1578 Commercial Residential
PERMIT APPLICATION FOR: 1�0 Select from dropbox, click arrow at the end of fine G os
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PROPOSED IMPROVEMENT tQCATlON'> t .ti4,
Address:
Legal Description: _
Property Tax ID #: yy3kL -
Site Plan Name: J&4 s
Project Name: �a
Setbacks Front
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000 - 2 Lot No.�
►� i"i, Block No.
Right Side: / Left Side: / d
SOO GAI(oh, PAht�.Tau..c ,C s. '
Q . 6N IV t'7'_��l 1. . S C MCI( S �
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`CONSTRUCTION 'MOM."
Additional work o e
— pe or T+
a under this p�rmit — check a that apply.
HVAC as Tank �s Piping _Shutters _windows Doors
_ Electric _ Plumbing — Sprinklers —Gene . rator _ Roof Roof pitch
Total Sq. Ft of Construction: I Sq. Ft. of First Floor:
Cost of Construction: $ _e�(� So , Utilities: —Sewer Septic Building Height:
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OWNERf LESSE .Y�, J s R t� CONT V OTM
Name Name:
Address: 2swl .c.J E12 A Company:
City: �.L/rl CITY tate: F Address:I;z(A StJ / ; F42Y
Zip Code: _34 �O 1 Fax:
Phone No.R�Te nfe5 ELtEiV&W City. PA►�x C� Stater
p ��
i Code: _ 14910 Fax:
E-Mail:T L1�4�-=,FL4s4Sr��-— Phone No. 9} 00
Fill in fee simple Title Holder on next page (if different E-Mail: E o c t r
from the Owner listed above) State or County License: d SS 7 4
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
I
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MORTGAGE COMPANY: ^ Not Applicable
Name:
DESIGNER/ENGINEER: _ Not,Applicabie
Name:
Address:
Address:
City:
Zip: Phone:
1 State:
1
:� -
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable•
`
1
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
1
City:
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 A,ssoclatlon 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.
STATE OF FLORIDA _�� STATE OF FLORID
COUNTY OF COUNTY OF
The forgo'ng instrugint was acknowledge efore me The forgoing instr e t was acknowledged before me
this�ay off 201�by this ay o 20 /9 by
zallw,.(��iys a n Z.51111q
(Name of per oh acknowledging) �ame of pe son acknowledging)
142
(Si re of Notaar77y Public- State of Florida) rnure of Notary Public- State of Florida )
P rsonally-Knowr ,� _ OR Produced.Ide ti `on lly Know OR Pro Icatio
Type of Identification Pro Type,of Identificatio EL• G0NN tida
,JANE E Stat�Cohflorida .`• � , Notary Public^ 036U70 0
Commissi _ � ,PJ P"�c'•s' otary Public GWGWO Commission •'o` . ° missio �' 1�0. 202
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