HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3- Z ' It SCANNED Permit Number:
BY
19t Lucie caffvty
•
Building Permit Application
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
JU3 --03N S
RECENED
MAR 121018
permitting Department
St. Lucie County
Residential
PERMIT APPLICATION FOR: To Select fromdropbox, click arrow• of
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Address: a703 Rod A'A e- /�� '�_VC, FOd rFi'f-M f f f2_ _30L5-/
Legal Description: filohfe ('4-do
Property Tax ID #: 133 q - -507, 0 , /y oo6 - 1 Lot No.��_
Site Plan Name: 14,e rt rt4 Ve-. f- Block No.
Project Name: �YL r
Setbacks Front Back: Right Side: Left Side:
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IHVAC GasTank Piping Shutters ❑ Windows/Doors
Electric Plumbing Sprinklers Generator a Roof Roof pitch
Total Sq. Ft of Construction: Sq. of First Floor:
Cost of Construction: $�j? a� Utilities: L_I Sewer Septic Building Height:
k&ITOR
Name S 1
Name' Q ► Y" i a. r►n vityl
Address: �70.3 Re,,A I•','n`e— P-f �
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Company: 1 r
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City: FBr f �,ie I'G'� J '; State: FG
Address: Dnn�/�
Zip Code: .r Fax:
City: Uap- 4,- eje' ,e
State: _ Z_
Phone No2 �g �� 4 g✓�lJ
Zip Code: c35/
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Fax: 7 72 • %f �Sf(�
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E-Mail: h ✓Qr- / 73 K(a Z o,4 ea nq
Phone No. Z- - -7
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E-Mail: Lll t.S
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Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUFPLEME�NTACONSTFtU�TION�LIENW�INFORM,TIO��
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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 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.
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Signature Owner/ Lessee/Contractor as Agent for Owner
Signature 01 Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5f L_uct- a
p
COUNTY OF �i l,(J2;.. _e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before
me
this _L2 day of fY1 / A 20 by
this j "ay of an4% ZA1 20-a by
/,{� ,/� J
C./ 44f2 1/ S'M /`f SSA(
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification v
Type of Identification
Type of Identification
Produced
Produced t>L'
all.
(Signature of Notary Public- to of Florida)
(Signat re of Notary Public- Stat FloridaCommission
No. (Seal)
Commission No. (Seal)Cg'REVIEWS
192-n�'
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DATE
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DATE
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COMPLETED
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tev.8/2/17