HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CUMPLETED FOR APPLICATION TO BE ACCEPI
SCANNED
Date: Permit Number: J W3 — 6`79 %
gNRI k. �� I10P�� RECEIVE
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Building Permit Application MAR 2 7 2018
Planning and Development Services
Building and Code Regulation Division Permitting- Department
2300 Virginia Avenue, Fort Pierce FL 34982 St L CI SR�nty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 COI mercial
PERMIT APPLICATION FOR: To Select from drropbox, click arrow at the end of line
F?ROPOSED IIUIPR{?11EMENT LOCATION
Address: 0/ &"Gl & l�D -J10S_�
Legal Description: / �a ,cl�,��t I oo/9 ZC &-kl
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Property Tax ID #: 13d U "94 U — r% / Lot No.�
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED
DESCRI:PTIQN OF, WORK
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CONSTRUCTION' IN FORMATION 3
Additional work toorme under tis permit —checka apply:
❑_ e
HVAC Tank ❑Gas Piping Shutters D/W
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Electric Plumbing Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
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Cost of Construction: $ odd Utilities: L_J Sewer Building Height:
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QUVNERf LESSEE ;.3 -
CONTRACTOR:
Name i6� w �' �ct/F iE
Name- v
Address: o/d/ Asa IL&O f 0 vD
Company: 60('0'4'h� S
City: /'-�, ��/LLfF State: r�
Address: *00 Iii ll d /V
City: �,=.:�; Stater
Zip Code: ,3Fax:
Phone No.� L 2613 bOgS
Zip Code: �35G �/ Fax:
E-Mail: ::6&J4rSA4aP�7e101t6A) l*,oA
Phone No. � 7
Fill in fee simple Title Holder on next page ( if different
E-Mail: 7/0 t/ P lid 6o6%,�U
State or County License: �'/�G /z�3/ Sv
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applica
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Appli
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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 o the issuance of a permit.
St. Lucie County makes no representation that is granting a ermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Assoclation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Associati n and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I c o hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building �nclergoing
odes and St. Lucie County Amendments.
The following building permit applications are exempt from a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, s�reen 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
improvemexlrwfyrk
your property. A Notice of Commencement must be recorded and posted on the jobsite
before the fspection. If you intend to obtain inancing, consult lender or an attorney before
commencin or recording our Notice of Co mencement. If
Owner
STATE OF FLORIDA
COUNTY OF
ee/Contractor as Agent for Own
G�Gc.�
The forgoing instrumen waknowledged before me
this �� day of s a 20/ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
1
Produced 01 ,
(Signature of Notary Public -
Commission No.
of Florida
nn,�D
(Se
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for oing instrument w s acknowledged before me
this day ofi7�� , 2011 by
10,
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of FI a )
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Commission No. (Sea tv
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