HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:�F��-f� 4,9 4i_ Permit Number:
DECEIVED
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Building Permi Application �.�n� : 9 18
Planning and Development Services
Building and Code Regulation Division Acie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: rcL, 1Cno .
Legal Description" verdole YaeY-i+-(2ie -Jo :Ds-n+� Un I+c9 G)CLP
L&+-s cZ9 *- a 4 COcP6 6C��,, c)r /100-635
Property Tax ID #: 3`i� -' �0� —�YP —05PQ0 Lot No.
Site Plan Name: IL.re-n DuE_,, Block No.
Project Name: 1L6_y_e_ ' 7D0(?_,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK"'
!9upPILJ ins-{01I )kP ILA Gef'eRC1Or U_)) ADO IP!ik4P
,_ erJ I o,e _C.(It - n�_f (-bje d-j-rCLn6_P-er (.5L&D I +C4--) u� 1
1066 8VO--r I ng Y-Y10d LUeS
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this; permit — check a apply:
1]HVAC Gas Tank ❑Gas Piping Q Windows/Doors
—Shutters
4&-Iectric El Plumbing Sprinklers ElGenerator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
'ZJ-'l• II -Sewer
Cost of Construction: $ Utilities: Septic Building Height:
OWNER LESSEE:
CONTRACTOR:
Name:
Name- 1 t�C�
Address: 3g G4_1
Company:'.
City: State:-CL-,
Address: fbinjobWOVOL.
Zip Code: 0� Fa V40
City:f(O
StatePhone
No.�1a-_
Zip Code FE-Mail: V
.
Phone N A �' (
Fill in fee simple Title Holder on next page ( if different
E-Mail:
i
-
State or ounty License. a
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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Y)
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:' _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
which is in conflict with any applicable Home Owners Assoc
structure. Please consult.with your Home Owners Associatii
In consideration of the granting of this requested permit, I c
in accordance with the approved plans, the Florida Building
The following building permit applications are exempt from
accessory structures, swimming pools, fences, walls, signs,
WARNING TO OWNER: Your failure to Record a No
improvements to your property. A Notice of Comi
before the first inspection. If you intend to obtain
commencins work or recordin vour Notice lof Co
emit will authorize the permit holder to build•the subject structure
tion rules, bylaws or and covenants that may restrict or prohibit such
i and review your deed for any restrictions,which may apply.
llhereby agree that I will, in all respects, perform the work
.odes and St. Lucie County Amendments.
lndergoing a full concurrency review: room additions,
reen rooms and accessory uses to another non-residential use
ce of Commencement may result in your paying twice for
iencement must be recorded and posted on the jobsite
inancing, consult with lender or an attorney before
Imencement.
I
Oignatu�re
O e / L'e ee/Contractor as Agent for.Owner
ature of tractor/License
Holder
STATE OF FLORIDA I
�' �`�
STATE OF FLORIDA-
COUNTY OF
COUNTY OF
The o o ' strume w c o led efore me
20�by
The f� st me w s cl nowledgl fore me
this of 20 y
this a o
y
1 CAA� r", V 1�--
0�
ame of r n making statement
Personally Known OR Produced Identification
Name of person
Personally Known person
aking statement
Produced Identification
Type of I entification
Type of Identificatio
Prod ed I
Produ ed
(Signa r f Notary Public- State of Florida) I
( gna re of Notary Public- State o orida )
a�b4A
,. trRYpUs�, ;JE);ItJfF RCORSON
Commission No. ''•
�G�lc
Commission No.
NNt ER C6RS )N
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Expires October 30, 2021
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Excfres Jctcber
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DATE
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DATE • •
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COMPLETED
Rev. 8/2/17