HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APF
Date: -7, I� _
,- 6UANNED
sM.,
Planning and Development Services
Building and Code Regulation Division
23DO Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CO171
PERMIT APPLICATION FOR: To Select from di
PROPOSED-,IMP.PROVEMENt LOCATION:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name: f (ki Q Mm I cone 11 MNd
Project Name: 1 —1 CA-.)C
Setbacks Front W Back: Right Side:
DETAILED DESCRIPTION OF WORK:'
TO BE ACCEPTED �Q
Permit Number: / D 03—(�y rQ�� )
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Application RECEIVED
MAR 3 0 2018
P itting Department
ial Residential Lucie County
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Left Side:. T
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56 we W e d e horn e.
CONSTRUCTION INFORMATION: {
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I�HVAC Gas Tank ❑Gas Piping
11 Electric 0 Plumbing Sprinklers
Total Sq. ft of Construction:
Cost of Construction: $ 12 370 6
OWNER/LESSEE:
Utilities:
Address: Lif)«rlJlS-�
City: Vntrk P't of ce State: EL
Zip Code: Fax:
Phone fro. _7] 7 e M®LJ390J
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Block No.
❑ Shutters Windows/Doors
nGenerator Roof Roof pitch
Ft. of First Floor: 16919
ISewer Septic Building Height:
3NTRACTOR:
npany: SIa�e wi4G f _T Cn
tress: , o lmb, c
r: ( State:,
Code: 139W� Fax: 963 4ft-0261
one No. &S-_ bb>q
lail: VLb Laws 99 iI- Cam
to or County license: .3(7 r)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
..SUPPLEMENTAL CONSTRUCTION LIEN.LAW I
FORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: �, Not Applicable
Name:
Address:
Address:
City: State:
City State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: xNot Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
i
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby mide 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 �eview your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do here y agree that 1 will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes rnd 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 dooms 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 finaniiing, consult with lender or an attorney before
commencine work nr recnrdinLavnur NntirP of rnmmonrpmnnt
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA .
i
STATE OF FLORIDA
COUNTY OF t)�
COUNTY O ���G
The instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this �- day of �AJQ irr- h . 2011 by
ILL
his day of ft Ird(1 .20A by
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Name of person making statement
I Name of pe on making statement
Personally Known X— OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
ype of Identification
Produced
roduced 1�2f(Sll r?A ( ktt liau 1
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(Signature of Notary Pu ' - State lorida j
(Signature o Notary Publi - ate of Flori j
Commission No.
Commission No.
Not®ry Public Stete of Florida
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