HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALCA4LICABLE INFO MUST BE CCIMPLETED FOR APPLICATION TO BE ACCEPTED
Q 22
Date: Permit Number: 0 �J • b `7�
Will �e�r• __ SCANNED
Bu1�i diet - . it Application RECEIVEp
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Planning and Development Services i
Building and Code Regulation Division MAR 3 1B
2300 Virginia Avenue, Fort Pierce FL 34982 p�,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ReSICtE f9 pa
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED"IMPROV- WENT LOCATION:
Address:'-1 Hai, f�lidlMn ( LIS— I na 1e� VI 34eig(o L
Legal Description:
a
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PropertyTax ID #: Lot No.
Site Plan Name: a Block No.
Project Name• � — — (500
Setbacks Front_ Back: I �L'_ Right Side: Left Side:
DETAILED DESCRIPTION.OF WORK:-
m0 b; to �\avw_ Cam
5ive Wide 6 one—
CONSTRUCTION INFORMATION:
Additional work to bEe 3nerrormedunder this permit— check all Inapply:
0HVAC Gas Tank ❑Gas Piping Shutters � Windows/Doors
_
L1 Electric 0 Plumbing Sprinklers E Generator F� Roof Roof pitch
Total Sq. Ft of Construction: So. Ft. of First Floor: 16919
LiSewerHSeptic (,-2
Cost of Construction: $ Utilities: Building Height:
OWNER/LESSEE: .
CONT . -OR:
Name WI-kM l )tJl? sMa %?_ lgow\ a 9afK
Name- _ Q_,,_�
Address: Lim' us'-@
Company: SSA i G -TP1C�.
City: t eU'z State:
Address: -, p p9r fkR4
Zip Code: '' Fax:
City: 1c la% State:
Phone No._ _77 � e ZS2m 4390i
Zip Code:' 13svC1 Fax: %'3 -696-07.61
E-Mail:
Phone No. %:6d 146- E90'1
Fill in fee simple Title Holder on next page ( if different
E-Mail: IlLn Lws 29 0? most (. Cp m
from the Owner listed above)
State or County license: 3(2C)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
MENTAL CONSTRUCTOON LIEULAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _2L Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: x- Not Applicable
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 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 1 will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes andiSt. 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-residentiai.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
commencine work or recordine vaur Notice of Commencement_
Irv- a—)-u
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ,
STATE OF FLORIDA
COUNTY OF M) I K11
COUNTY OFF �
The f oing instrument was acknowledged before me
h
The fo oing instrument was acknowledged before me
`�
this day of r1 to irk, . 26 by
this day of Ma 12(A . 20J by
Name of person making statement
Name of pepson making statement
Personally Known_ OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
Type of Identification ��pp
Produced_ Ir �(ll1'h;�1
Produced � 1 e S1 I tYA (kLI• Kluc�yi
(Signature of Notary Pu ' - State lorida)
(Signature 'o Notary Publi - to of Flori
Commission No.
Commission No.
,% Notsry Public State of Florida
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Rev. 8/2/17