HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONIL
ALL APPLICABLE INFO MUST BE
Date:
.ETED FOR APPLICATION TO BE ACCEPTED `
SCANNED Permit Number:
By
StLudeCnuntv
uilding Permit Applicatio
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
RE EC IVED
MAR 13 2018
ST. Lucie County, Permitting
!sidential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT.. LO(ATION::
Address: of 1 n)'
Legal Description:
r,
Property Tax ID #:
Site Plan Name: 1
Project Name: ,( ;F
Setbacks Front Back: Right Side: Left Side:
DETAILED`DESCRIPTI6N OF"WORK
fie - eN- � � �' ` `b � f -tv
0,/J, k'ad � T- mew �-
s{�
w Cj
Lot No.
Block No. 116
CONSTRUCTION INFORMATION
-;
Additional work to be nerformed under t is permit-' check
❑HVAC Gas Tank ❑Gas Piping
all that apply:
D_ Shutters
}
Windows/Doors
1:1Sprinklers
�
-Roof
Electric Plumbing
Generator
Total Sq. Ft of Construction: oXo
S . Ft. of First Floor:
�
Cost of Construction: $ 61GO
Utilities:
I
Sewer
OSeptic
l
Building Height:
'OWNER/LESSEE:` >=: :::
CONTRACTOR
Name
Address: L
Name:
Company:
(' S
G P's t?
City: State:-[:�
Zip Code: Fax:
Phone No. _-7-70
E-Mail:
Address: 33q/
City: ,%� `f State:-39-
Zip Code: Fax: '17,-2---2j:5!77((-3
Phone No. 77,-,?-
E-Mail: v C GYM
State or County ense: CSC 7e
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
it value or construction is :�csuu or more, a KtLUKUtu Notice of commencement is required.
SUPPLEMENTAL CONSTRUCTIOI _C, N LAW INFORMATION:
DESIGNER/ENGINEER: _ Not'Applica
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
Phone:
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 or recording vour Notice�of Commencement.
V
_ Signature of Owner//Lessee/Agent
STATE OF FLORI
COUNTY OF
The f r oing instrLu3:Le;?t was acknowledge efore me
thism day of FdoyL, a 20 �by
(Ngkneooff�pery C
owdedging)
/ / i _ /// /_-)
Notary Public- State
Personally Known OR Prod ntjfication
Type of Identification Produced j—
�'i,.�� � tits
s
Sig ature of Contra or/License Holder
STATE OF FLORI rl
COUNTY OF ��
The forgoing instrum nt w�a�acknowledged before me
this i� day of (,L20 by
.I I�
(Name of pers n acknowledging )
(Signatulre of Notary Public- toe f Florida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.(�4
RESTIFO z REBECCA RESTIFO
L
My COMMISSION # GG91 i X63
�o EXPIRES: May i'1, 2021
Revised 07/", EXPIRES: May 17, 2021
J
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