HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICA L 7tF
E COMPLEI a FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SGA90
By
stalc 'di�'i1 tv
Building Permit Appli
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
PERMIT APPLICATION FOR:
Address:
Legal Description:
Aa3 "6Q �(0
RECEIVED
tio,i AR 2 2 2018
ST. Lucie County, Permitting_
Residential
PropertyTax ID #: 2 Z 1 d(7�� C�OC2 �7 Lot No.
Site Plan Name: Block No.
Project Name: s'
Setbacks Front Back: Ria'ht Side: Left Side:
Aaaltional worK to be pertormea unaer tnis permit— cnecK an mat apply:
_Mechanicalas Tank as Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ L ?-eeno Utilities: —Sewer —Septic
Name .4-C-r I— JC:V I I PIC11-1 �J
Address: `?Z 0 CeRCLEC:
City: L— State:
Zip Co e: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page;( if different
from the Owner listed above)
Name:
Windows/Doors
Roof Pitch
Building Height:
Company: pw ivy-:
Address: 1 0&
City: zt State:
Zip Code: Z Fax: 22� �k& 19
Phone No 2" tL 16-2
E-Mail Pic-) c'lve— 1
State or ounty License 2-1 4 J
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
'PRL y ItI
AT 11 '
DESIGNER/ENGINEER:
Name:
_ Not Applicable
1
MORTGAGE COMPANY: Not Applicable
Name:
Address:
'City: State:
Zip: Phone:
Address:
City: State:
Zip: phone
FEE SIMPLE TITLE. HOLDER:_- i
Name:
Address:
City:
Zip: Phone:
Not Applicable
- #
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby m"ade 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 prop rty. A Notice of Commencement must be recorded and posted on the jobsite
before the f' inspection/If you intend to obtain financing, consult with lender or an attorney before
commenc' g w rk orlrecjk,ingour Notice of Commencement.
W W/1 Z4, i i
Signatur of Owner a ntractor. as Agent for Owner
Signature Contractor/Licenseolder.,,,,,, H
-,
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sk. V%x- \ e
COUNTY OF S - '--ftx�
i
The forgoing instrument was acknowledgeq before me
The forgoing instrument was acknowledge before me
this'4,a— day of , 20_Vr by
this day of yr, q, ( 20 T by
(Name of person acknowledging)
(Name of person ackno Kedging )
(Signature of Nota. ublic- State of Florida)
(Signature of Nota Public- State of Florida )
Personally Known OR Produced Identification i
Personally Known OR Produced Identification
Type of Identification
Type of Identif* ation
'
Produced ^ ¢'l, L
Produced 7 lr GIVENS
IE GIVENS
Commission No. 46 �}iNAMA� p23
r ; SSION # GG 022
'; t 2020
IPP :eon•'•
G MIAISSION # GG 022023
ommission . � _ ES:DecemberI
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