HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ✓ �i'� V �6��tr�� Permit Number: I,U�'� 3 3
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Building Permit Application MAR 2 8,1018
Planning and Development Services
Building and Code Regulation Division permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 t. Wde county
Phone: (772) 462-1553 Fax: (772) 462-1578 'iCommercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LLOCATION: /�
Address: / lL. =-/&/'5 Y� �% H q
Legal Description: h vl - C,r'iId '_I — 6A 5
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Property Tax ID #: o� y� -o - �� ' Qr�- A Lot No. `7
Site Plan Name: Block No.�
Project Name: i
i
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
&l?/1ove - IY4-
CONSTRUCTION INFORMATION:
Additional work to e e orme under tis permit -ichecka apply:
❑HVAC F] Gas Tank Gas Piping Shutters Q Windows/Doors
❑ Electric Plumbing Sprinklers Q Generator Roof Roof pitch
Total Sq. Ft of Construction: S . L. of First Floor:
Cost of Construction: $ /O j ���_ Utilities: Sewer Septic Building Height: 1_
OWNER/LESSEE:
CONTRACTOR:
Name I'
Name: Ublf
Company: k5 kv'
Address:
City: / "Q f, unn State: I ILI—
Zip Code: 6LIgx 7 Fax: /]� 2 I
Phone No. %%? c��7 �`� �_)
Address:W.
City: Q State:
ZipCode: 3%Q�% Faaxxp%%R �V TI (63
E-Mail:
Phone Now. "�102
E-Mail: Luc-��Ql���.L'�Lf
State or County L ense:/iC0.�7n-I
—r
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
I
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 recordine vour Notice of Commencement.
YVAAlfA t ft �,D
Sign ure of Owner/ Lessee/C n racto s Agent for Owner
Sign re of Contractor/ icense Holder
STATE OF FLORID ��'�,,,, '� ��=�
STATE OF FLORI A' /
COUNTY OF ���ccs-Tff�I
COUNTY OF
The forgoing instrun e t was a knowledged before me
this R day of Q 20�by
The forgoing instru a it was knowledgeefore me
thispl�(, day of 20 by
/ ,.
Lu l/ `l(.�
Name of person making ftatement
Name�iEaking statement
Personally Known OR Produced Identification
Personally KnoOR Produced Identification
Type of Identification
Type of Identification
Produced
I
Produced
(Sigriatur of Notary Public- State PHrid
(Signature of N tary Public- State of Flori )
Commission No. q (Seal)
Commissio I)
REBECCA RESTIFO
COMMISSION # GG91863
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DATE
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DATE
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tev.8/2/17