HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICAIBLE INFO MUST BE�Cq (M/PLETED FOR APPLICATION TO BE ACCEPTED
Date: �-f • 7 ' i PermifNu
Building We"t"M %plicatio
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
E i v ED
APR -3 2018
Permitting Department
St. Lucie �,Qunty, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: -740q
Legal Description:
cPe I e L-04- I-E; OLna na�--
i M A,S in or e�73- seXP1
Property Tax ID #ft /pS- Lp( �J—C_JC ��" VC�J - T Lot No.
Site Plan Name: �� 1 (�L�Q� Block No.
Project Name: JLr
Setbacks Front Back: Right Side: Left Side:
I-n &CU
SUVI
w
�� 11HVAC IJ Gas Tank ❑Gas Piping
Fklectric 0 Plumbing L]Sprinklers
LJ Shutters
Generator
Windows/Doors
Roof Roof pitch
Total Sq. Ft of Construction: c S . Ft. of First Floor:
Cost of Construction: $ 9C%J . 49 0 Utilities:cnSewer ElSeptic Building Height:
OUV:NER/.,LESSEE ' �� Ems. xC®NTRACTOR
;h
Name
Name: 1
Address e 1 -Qi L b1
Company:
City: ( _ C� Statef C,
Zip Code: Faxn -�( IPVY�
Addre `�S-e i1i -�
City: V + Staith-
Phone No. - � -
Zip Code Fax:Z17 -
E-Mail: -C ) I.
pV �7
Phone No.7 '- O.� T 34..
Fill in ee simple Title Holder on next page( if iffe
E-Mail: N1Q(
State County License:
from the Owner listed above)
If value of construction is $2500 or'more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION
LIEN LAW INFQRMATION,:
....
t
DESIGNER/ENGINEER:, . ..
Not
Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: "'
Name:
Address:
`''`` `'' I
Address:
City:
State:
City:, State:
Zip: - 'Phone,
�I
Zip: Phone:
FEE SIMAE'TITLE HOLDER;
; , . _< Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
I
Address:
City:
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.
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 requestLd 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 recording our Notice of Commencement.
Signatu of n r/ Lessee/Contractor as Agent for Owner
Ignature of C t ctor/ icense Holder
STATE OF FLORID r
F ORIDI�
COUNTY OF�� Ihl l�
COUNTY Q
The r pi; instrume wa c nowledig efore me
thi day of 20 �
The f i strum t a knowledg fore me
this � day of 20� y
amlew, , f 1 ax 11 l' cal
I 0Amoj-1
Name of per making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id t' i lo� ^^ i f
Type of Id nt• . io n��
Produce 'j`�� ry j
`��
ik
Produce V
of NiQI;�� ubli pM®bfkMa.)
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REVIEWS
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PLANS
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DATE
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RECEIVED
F;<Lirts�ca-.'erI
2021,
DATE
0FF19
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ry
COMPLETED
Rev. 8/2/17 °`w JFNINIFER CCRSON
�. COiriGtissi5:} 0, G3156192
obs:2021,
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