HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONa . s
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date: Permit Number:
k4o3-dSgs
SCANNED Fn
EIVED
NEWS�� ��P.i� P,�I��v
Building Permit Applicati 2018
Planning and Development Services nty, PernlI€ nu
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462I 1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line y.S D
Address: / �997
Legal Description:,
Property Tax ID #: o/d Lt 0
Site Plan Name:
Project Name:
Setbacks Front 13y ` Back:
Aaamonai worK to D errormea
11HVAC Gas Tank
11 Electric El Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ O C
Az2. a rK La4
Right Side:
Ca6�
Left Side: J -2o r
0Ll - 11917 7
Lot No.�
Block No.
danc( lt;le� -7� az'e"'t"'
3ermit — cnecK an apply:
Sas Piping _ Shutters
Sprinklers 13 Generator
S Ft of First Floor: _
UtilitiesSewer OSeptic
QWindows/Doors
F]Roof Roof pitch
Building Height:
4.CNNER LESSEE:
CCINTRA tQR: ��,
Name 1hoes
Name: G-e.i !-*--
Address:_/,�? eQ L/ (ems SYIr `T .r'�
Company:
City: Ps(" I State: Pf-
Address: /6 S? S. ganh.Eai
Zip Code: 14q?7 Fax:
City: ,S-*e111f State:
Phone No.
Zip Code: .3 M5� Fax: 79I 1Ia'9
E-Mail:
Phone No. 77a- 7.,f/-���'
Fill in fee simple Title Holder on next page ( if different
E-Mail: 4076
from the Owner listed above)
State or C unty License:
I If value of;construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
I
s P � � � co sr ; a �►w � �oR
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address:
City: I State:
City: State:
Zip: Phone I
I
Zip: Phone:
'
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name'
Name'
Address: I
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ -CONTRACTOR AFFIDVIT: ARIplication 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 th
which is in conflict with any applicable Homl
structure. Please consult with your Home Ot
In consideration of the granting of this. regw
in accordance with the approved plans, the
The following building permit applications ai
accessory structures, swimming pools, fence
WARNING TO OWNER: Your failure to
improvements to your property. A N
before the first inspection. If you int(
commencine work or recordinE vour
t is granting a permit will authorize the permit holder to build the subject structure
Owners Association rules, bylaws or and covenants that may restrict or prohibit such
ners Association and review your deed for any restrictions which may apply.
.ted permit, I do hereby agree that I will, in all respects, perform the work
orida Building Codes and St. Lu�ie.County Amendments.
exempt from undergoing a fu� concurrency review: room additions,
walls, signs, screen rooms an accessory uses to another non-residential use
Record a Notice of Commencement may result in your paying twice for
tice of Commencement must be recorded and posted on the jobsite
id to obtain financing, consult with lender or an a ney before
Jotice of Commencement`!.. /1 I
Signature( of Owner/ essee/Contractor as Agent
for Owner
Signatu of Contractor/License Holder
STAT O�lF FLORIDA
A/LTAI
STAT OF FLORIDA,�n
COU TY OF
COU TY OF
The forgoing instrument was acknowledge
this day of iw a 20
before me
by
The for oing instrum nt was acknowledged -before me
this day of 20by
Name of person making statementl
Name of person making statement
Personally Known OR Produced Identification
Personally Known _> OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
o,' 4111,
(Signature of NotaryPublic-
a te of Florida I
Commission No. $��i � (
I QEANNAMARIE GIVENS
MPAISSION#GG0220
C
CINDY L N LACONTE (Se I)
_
:o; EXPIRES:
`'
of 6 ' Bonded
December 16.202
Thru Notary Public Unde
ter.
=. Q ,Lateo
; �; f Florida
' My Comm. Expires Apr
��%�f p�J� p 2,9, 2018
•.,,,,,,,,,••` Commission F
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DATE
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COMPLETED
Rev.8/2/17
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