HomeMy WebLinkAboutBUILDER PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETEDIFOR APPLICATION TO BE ACCEPTED 1
Date: 3 ) -M Il Permit Number:
SGANN D
I
Lu
cie RECEIVED
Budding Permit Application MAR 13 2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-' 578 Commercial - Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCTATIO'N':
r
Address: �.
Legal Description: Ok-U C )Rba S l - /c Q - 33.ce
Property Tax ID #: Lot No.
Site Plan Name: I Block No.
Project Name: F
Setbacks Front r Bac!k: Right Side: Left Side:
DETAILED.:DESCRI'PTION OF":WORK:
re-W /Yu- 4&-v �Z4 -
CONSTRUCTION" INFORMATION ���. - „ ",
Additional work to be nertorr a undert Epermit -checka appy:
❑HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers Generator -Roof
Total Sq. Ft of Construction '7p0 S . Ft. of First Floor:
I �}
Cost of Construction: $ {D ��, �o Utilities: Sewer[]Septic Building Height: /a
i
OWNER/LESSEE:: f`,::
`CONTRACTOR:
Name
Address: 07�7L
Name:a IaS
Company: Q � !/l
City: 4 _4P_i'U State: a
Zip Code: Fax:
Phone No. -7-70 9-7-7LI
Address: 33�1/ � Q
City: State:%
Zip Code: -,*WW7 Fax: '77,2_-2iS�774,3
Phone No. 77P-
E-Mail: v ` C 6yt l
E-Mail: ��
Fill in fee simple Title/Holder on next page (if different
from the Owner listed above)
State or County ense: CSC 1-5�-0:)71-'
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUC N LAW INFORMATION:
I
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address:
City: State:
City: State:
Zip: Phone:
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City:
City: I
Zip: Phone: I
I
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 pelrmit, 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 exemlpt 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.
Le I s
11
_ Signature of O ner/ ssee/Agent Sig a ure of Cont ctor/License Holder
STATE OF FLORI STATE OF FLO
COUNTY OF /�C h COUNTY OF O
The forgoing instr��mm��nt was acknowledged fore me
thi: day of I-Y ) it 20 by
of perfdr( ac�ndwledging )
(Signature of Notary Public -
Personally Known OR Produ
Type of Identification Produced
Commission No.)M'1[ 0P0, e�sP
0
� �pP
Revised 07/15/2014
The forgoing instrument was facknowledged before me
this � day of lv(ILyn 1 . 20 /9-by
s E ae-
(Name o p rson acknowledging)
rida) I (SignatiAe of Notary Public- 9tat ofj Florida )
I I ti icatiorf- Personally Knowrr� OR Produced Identification
_ �,,.,,, Type of Identification Produced
3I6N#GG91963 Commission No. "r
May 17, 2021
er�n�'% REBECCA RESTIFO
�t� MY COMMISSION # GG91863
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