HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1 ALL APPLICABLE INFO MUST BE COMPF _ D FOR APPLICATION TO BE ACCEPTED
Date: `a l �-b % Permit Number: 1�a3-d
NAMED/ REOE��EO
Ely
BA&Alf'e i' Applicati n MA peCmlttin9
Planning and Development Services SY, Lucke County,
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
PRODOSED IMPR01lEMENTLO=CA�fIQN „ f ��.pp. ��
Address: L, I / ' u ` V1 1 r
Legal Description: � '6 ��, ) LQ
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILE6t, DESCRIPTION
s o\ c� eo CA '0
Side: Left Side:
Lot No.
Block No.
CONSTRUCTION IN°ORIVIATION
Wec
Additionalworkkto
orme urider
fi
this permit-- c a
apply:
❑ HVAC
Gas Tank
Gas Piping
❑ p g
_
Shutters Windows Doors
❑ /
11
Electric
❑
Plumbing
Sprinklers
❑
Generator
❑
Roof
Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
i
Cost of Construction: $ �( (� (� Utilities: _ Sewer 0Septic Building Height:
i
011VNER%LESSEE, ° j = `
:CONTRACTOR y F
Name O S
Name:
Address: d k ,- V
Company 1
City. stiOiX
Address: R
Zip Co e: (R C� J Fax:
City. Stat
Phone No. °� c��
Zip Co e: � Fax: 7
E-Mail:
Phone No.' 1� cam- (1)
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
It value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI&v�IEN LAW INFORMATION:.
DESIGNER/ENGINEER: _ Not Applicable
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 lauthorize 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 undergoingla 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.
I
Signature of Owner/ Lessee/Contractor as Aden for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLQXQA
COUNTY OF
COUNTY OF
The forgoing instrumgnt was acknowledged before me
I
The orgoing instr} was ack, owledged before me
A
this � � day of 20�j by
this day of 0 1 I 20L% by
Name of peV1 making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known _�C OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
I
(Signature o otary Public- ate of F orida
(Signature of NotWy Public- State o Florida
Commission No. <�"y"�°•, KARLEYMARI (fVARNEY
tary Publit�6f Florida
CO 0. KARLEYMARIEGIESY- VARNEY (Seal)
—NetagfRttbHe- 3tateeFlorida
`_•' •= CommisslonkGG099801
'•' •`• CommissiankGG049801
My Comm. Expires May 1, 2021
"6 �oF o;:` My Comm. Expires May 1, 2021
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tev. 8/2/17