HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO/MUST BE COMPT%TETFOR A[;PLICAIION TO BE ACCEPTED
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Building ApplicatioPR - 3 2018
Planning and Development Services Permitting
Building and Code Regulation Division Department
2300 Virginia Avenue, Fort Pierce FL 34982 cie 0 nty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATIONFOR: To Select from dropbox, click arrow at the end of line V)e_r0cq
PROPOSED IMPROVEMENT LOCATION:
Address: ,g7Co-7 34- coC , In I c_Q
Legal Description:
Property Tax ID#: S/(26(/19 —WQ'
Site Plan Name: _
Project Name:
Setbacks; Front Back: !,Right Side:
Left Side:
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK: At IN i-tCrUSI ` om
ron( dice- V_e__hCU_(1 _1b ca�(J
y� �
04. /ns 0&0 a (5l k) n-oa& 6lu,6w s
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit — check a apply:
F]HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
11 Electric ❑ Plumbing ❑ Sprinklers ❑ Generator 19-Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: oR;O 3
Cost of Construction: $ /./ /5s°O Utilities:]Sewer Septic Building Height: �� I
OWNER/LESSEE:
CONTRACTOR:
Name Allrftl Of7 S
Address: 746 '
Name:
Company:
/hC
City: ('u Stater
Zip Code: 3 41rq (& Fax:
Phone No. —770 S(S �05(o3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address:
City: State:
Zip Code: 5qL?q7 Fax:
Phone No.77o� OS-7
gl C'ISNT
E-Mail: Gil�lry,-Uf-
State or County I ense:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUC LIEN LAW INbORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: 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 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 your Notice of Commencement.
Signature of Owner/ ssee/Contractor as Agent for Owner
Signature of Contrart or/L' ense Holder
STATE OF FLORID �//'
n
STATE OF FLORIDA
COUNTY OF�YIGr!A
COUNTY OFQ.f"l�
The f oing instrum nt was cknowl edg fore me
this day of 20LD
The forgoing instrument as acknowledged before me
this day ofAQ CU 20JS by
V i? S
-n('s-UC (CAS E r26 e--
Nanlejof person making statement
N e of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden ' ' ati /
I�f--
Type of Identification
Produce
Produced
(Signatuf Notary Public- State f F on a)
re
(Signature f Notary Public- State f o )
Commission No. ?j (Seal)
Commission No. EIagll R& , (Seal)
REVIEWS
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P�, 17.202
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DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17