HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL -APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: 2 - 3 I l8 I Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3•
Phone: (772) 462-1553 Fax:(772)
PERMIT APPLICATION FOR:
P,R®P,�®SErD IIVI;r.*r.I IVIENM
Address: DOrl1Q�)
Legal Description:
-Property Tax ID #:-1I
Site Plan Name: I Q I
Project Name: ,00_0
Setbacks Front
FRECEIVED
gilding Permit Applicatio2 2 2018
unty, Permitting
1578 Commercial Residential
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SIC-61101�1
r'e6er�
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Right Side: Left Side:
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S 1104
Lot No.
Block No.
erctf -p e
Avviipr `J "c eft --I rZ G�2
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Additional work to be nertormed under this permit - cnecK an apply:
11HVAC l_J Gas!Tank ❑Gas Piping _ Shutters
alectric 0 Plumbing ❑Sprinklers. ElGenerator
I
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
UtilitiestSewer OSeptic
QWindows/Doors
0 Roof Roof pitch
Building Height:
Name oukU01 Qa,
Name:
Address: l0 I 1c0C
Company:
Address:
City:f'�- State -�1.�
Zip Cod Fax % lSJ
ty: `CJy State:
�1�- ,l-
Phone No.%_I � - -1 13 ,-t }
Zip Code:
Fax: 1
0 �_`
E-Mail: n IC 1 I
I hone No. -
E- ail:ig
'
Fill in fe imple Title Holder:on next page (if differen
State or ounty License:
from the Owner listed, above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTIONLIEN LAW INFORMATION; ;, v'�' ='
DESIGNER/ENGINEER: _ Not Applicable I
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
' I
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.
1 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 � ill authorize the permit holder to build the subject structure
bylaws
which is in conflict with any applicable Home Owners Association rdles, 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 Commmencement 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 recgrog y9i4rNotice of Commencement.
I
Signature of Aner Lesse /Contractor as Agent for Owner.
Signalur of ontr or/License Holder
STATE OF FLORID I I I
STATE OF FLORIt t 0 I
COUNTY OF lam-
The efore me
COUNTY OF Y'��
Thetr e a n ledgfore me
ru n s edg
this day of . 20 � by
thi20� 0 by
L n
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Name of p rs n making statement
Personally Known � OR Produced Identification
Name of person making statement
Personally Known OR Produced Identification
Iden 'f'
/ ' , l/�Type
Type of Idenmbo&Lmk t kA `
of
atioProduced
Produced) o
t1J
01u/VL—
AIMP
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(i ture of Notary Public- State of Florida)
naturelof Notary blic- state -of Florida )
Commission No. (Seal)
Commission No. �Nlttt���NNry� (Seal)
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COMPLETED
Rev. 8/2/17