HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONe' r-
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED v Q (�/
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Date: u J 1p
®4UIIU� 8,2n1* Permit Number:
AG 00z?1b
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 RECEIVEp
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To S lect from dro box, click arrow at the end of line P' 1018
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.PROPOSED. [MP—ROVEMENT LOCAYION: Lucie cou� merit
Address: (NO.-yn IDS-i) eme V0 346Mo LAB- ,
Legal Description: . 1
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Property Tax ID #: Lot
Site Plan Name: 1 'd O Block No.
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Project Name: `-1 1
Setbacks Front_W Back: ---Id--- Right Side: Left Side: [.'
-DETAILED DESCRIPTION -'OF WORK: 1
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CONSTRUCTION INFORMATION: 1
ACICIltionalworKtOpenerformedunder tnis permit- cec all= apply:
IIHVAC Gas Tank []Gas Piping Shutters ❑ Windows/Doors
_
0 Electric 0 Plumbing Sprinklers Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S . R. of First Floor: 16 619
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Cost of Construction: $ �7 �� Utilities:11 Sewer Septic Building Height:
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-.OWNER -LESSEE:
CONTRA_ CTOR:
Name %!IbAl 0:119 1A6% �WM E gj
Name: }'��
Address: m'T us- `
Company: SSA l 4 G _T_nG
AY34
City: tefcc State: n
Adtlress: P, t 2 dk
Zip Code: Fax:
City:� f=mmicStater
Phone No. -7-7 ^I_- -M-• S395
Zip Code: `339bol Fax: -616-oU l
E-Mail:
Phon� No. Vff" R04
Fill in fee simple Title Holder on next page ( if different
E-Mail: ) n SRI rQ6MQ.rpM_
from the Owner listed above)
State or County License: 226Z 0
If value of construction is $25t10 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I State:
City: State:
Zip: Phone I
i
Zip: Phone:
FEE SIMPLE TITLE HOLDER: N'' Applicable
BONDING COMPANY: Not Applicable
Name: I
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone:
I
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 commFed prior to the issuance of a permit.
St. Lucie County makes no representation that IIIs granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home 0 ners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Own rs Association and review your deed for any restrictions which may apply.
In consideration of the granting of this request 'd 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 e> empt 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 properly. A Notici of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend #o obtain financing, consult with lender or an attorney before
commencine work er recerdine veer NntirP of rnmmPnrPmPnt_
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA .
STATE OF FLORIDA
COUNTY OF F) I
COUNTY OF_ Dn
The forgoing instrument was acknowledged before me
day
The fo�r �oing instrument was acknowledged before me
MO
this of�l1JfA i�l� . 20 by
this-1 day of Irdl . 20 JI by
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Aaro(I lnr)ccu t�
Name of person making statement I
.
Name of pe on making statement
Personally Known_ OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
Type of Identification
Produced_ P�3 �fY1'h;fl
Produced 10e_(_�d)f1G�telf Klu vIi
(Signature of Notary Pu ' -State lorida j
(Signature of Notary Publi - to of Flori
Commission No.
Commission No.
Notary Public State of Florida
a StaRrtof Haoda
V10111111� 1111 Lam
Victoria Laws
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REVIEWS
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REVIEW
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DATE
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RECEIVED
DATE
COMPLETED
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Rev. 8/2/17