HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: 7 o 1 '3 Permit Number:
SCANNED
RECEIIYED
• St Wide QW01,
Building Permit Application MAR 14-2N
Planning and Development Services Permltting Department
Building and Code Regulation Division St. Lude County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Comme Icial Residential
PERMIT APPLICATION FOR: To Select from dropbox. click arrow at the end of line
Address: d
Legal Description:
Property Tax ID #:
Site Plan Name: _
Project Name:
Setbacks Front
/ <
Back: `-I" _ Right Side: _
Left Side:
Lot No.(4,(—_
Block No.
Additional worK to be errormeo unoer tnis permit— cnecK all apply:
13HVAC [] Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
Electric 0 n Plumbing []Sprinklers OI�Generator Roof Roof pitch
Total Sq. Ft of Construction:
r / S . Ft. of First Floor:
Cost of Construction: $ °� Utilities: 11Sewer OSeptic Building Height:
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�OINNER/CESSE L'
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Name
Name:
Address:OUVe__%
Company:
City: ToxfE e _ State: JL-- •
Address: aZ
Zip Code: *; !J Gi ;7_ Fax:
City: Qkx:±- e__
State:�i .
Phone No.
Zip Code:'Fax —
LW
E-Mail: w►
Phone No. — (0 1
Fill in fee simple Title Holder on next page (if different
E-Mail: 3v. a�✓o o
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from the Owner listed above)
State or County License: G
5
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLENIENI"A bNSTRUCTION LIEN LAW INFORMATION
DESIGN ERIENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: PniPiv� %00A_
_
Name: �/&
Address: !}So Svc/ ,u L+;;,�,. '17�;✓�
Address
City:. j� �_Cd! _(�, <'," e, State: �PL_
City: State:
Zip: 2,4C,5Z Phone ��7_-3 �$ — ��_
IZip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
',BONDING COMPANY: Not Applicable
_
Name:
!Name: WIA
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 fir t inspection. If you intend to obtain financing, consult with lender or an attorney before
commencirAXuorkorrecopf rng voudNotice of Commencement. /n ..111
of
Agent for Owner
STATE OF FLORIDA I STATE OF FLORIDA I
COUNTY OF i . L.Tr;. Q _ COUNTY OF S�' - L►� [� ,�
The for mg instrum nt was acknowledged before me
this (< day of MzArcA& 20A by
Name of perso making stafsakrit
Personally Known OR Produced Identification
Type of Identification
Produced
The forming instrument was acknowledged before me
this � day of Ma., r-LoL 20A$ by
Name of perso aking statem
Personally Known VOR Produced Identification
Type of Identification
Produced
z V7_4�
(Signature of Notary Public- State of Flnridn j__�
,.:Isr%i% ANDREW GRASSO
�;;:� ANDREW GRASSO
Commission
- ISSION kSP*8252
Commission
I
Ii1a''
ISSION #(J252
'?efM1� EXPIRES June 02, 2020
EXPIRES June 02, 2020
(407) 398-0153 FloridallotaryService.com
(407) 398-0153
Flo rldallotaryService.com
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Rev. 8/2/17