HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO MUST BE COMPLFZED FOR APPLICATION TO BE ACCEPTED
Date: � ' �� � �� �Permit Number:
rx A" ��: SCANNED
Wilta"I'A Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4627-1578 Commercial
PERMIT APPLICATION FOR:
Address: Li IU I�i� ✓' " ,1�1
I
Legal Description:
Site Plan Name:
Project Name:
Setbacks Front
r 11 500 _ CO -3 , CD6-- '—e
Back:
Side: Left Side:
Residential
Additional work to be pertormed under this permit - cnecK all triat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: I Sq. Ft. of First Floor:
ICost of Construction: $v oLeSl 4� SOD✓S Utilities: _ Sewer _Septic
L 3
Lot No.
Block No.
- Windows/Doors
Roof Pitch
Building Height:
01lVNER�LE=�SSEE:
Ci7NTRACT®R:
Name sz
Name:
Address: V�C�
..
Co,mpa'ny,.:
City: State: Ft�
Zip Code: �IQS} �i Fax:
Phone No. V a b - Y Le %—b-7,;�
Address:
City: State:
Zip Code: Fax:
� Phone'No '
\E-Mail:
e- OQ LA
-.e L
Fill in fee simple Title Holder on next page ( i 'different
from the Owner listed above)
E-M'ail .-Y•
State, &-Couril!ty License
,
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required. II
SUPRL IIENTA� Ct�NS IJ C?N I.IC I FOR TLeg
DESIGNER/ENGINEER: _ Not 1Applicable
MORTGAGE COMPANY: Applicable
Name: I
_"ot
Name:
Address: I
Address'. -
City: State:
City: State:
,
Zip: Phone I
i
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: mot Applicable
Name: I,
Name:
Address: I
Address:
City: ,
City:.
Zip: Phone:
Zip: Phone:
I
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 '1
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. t'
In consideration of the granting of this requested Ipermit, 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 exelmpt 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 Jof 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 our Notice of Commencement.
%tomi\�t _.'-r�
61 R('A f
-
t ure o Owner/ Lessee/Contracto for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S+
COUNTY OF
The forgoing instrument was befo le
The forgoing instrument before
acknowledged me
was acknowledged me
this 1I day of 120 19 by
this day of 20_ by
1. t? I (* i;�50 L I.e4
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary P c-State of Florida)
(Signature of Notary Public- State of Florida )
I
,F
Personally Known OR Produced Ident
Personally Known OR Produced Identification
Type of Identification ,,,js"."dr,
Type of Identification
Produced
Produced
Commission No. (Seal 1 cn
Commission No. (Seal)
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