HomeMy WebLinkAboutBUILDING PERMIT APPLICATION\-`f .
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED "
Date: `11�j '� Permit Number:
SCANNED RECEIVED
r BY
St Lucie CountyAPR 2 6 2018
_ Building Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: o
Legal Description: W kt
Property Tax ID #: _1-1)`T'0&_A
Site Plan Name: Sty iZl
Project Name:
Setbacks Front c%�� Back:
K
of OCD(O Is Lot No._
Block No.
�1
ght Side: • �W Left Side,�
a50o ?Si h , - �n-t- �-_t
Additional work to be pertormed under this permit- cneck all tnat apply:
_Mechanical _ Gas Tank Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: I Sq. Ft. of First Floor:
Cost of Construction: $_'QA tQ) ,t)6 Utilities: —Sewer —Septic Building Height:
01N�N!ER///LESSEE:
CRNTRACT®R:
Name_(D� . I �`- '
Name: -.K-oknv, Qrnc
Address: -' 7/.>r) St_.u, )A
Compan
i
City:Stater
Zip Code: ,3 q � 7 7 _ Fax: 'I
Phone No. _ 7a - 00/- �2/ 6 S i
Address
City: U 21AA 4„12 , Stater
Zip Code;349X2 Fax:
Phone No `7'72 - QC21 - S/ (OP5
E-Mail
E-Mail:
Fill in fee simple Title Holder on next,page ( if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CM UCT QN UN LAW INFORMATION:
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/ LC-ssee`CbMracto`r as Agents for Owner
STATE OFTLOB AL Jc,` e
COUNTY OF =
Theforgoing instrument was acknowledged before me
this d ccoo day of Ci t r "A , 20_ft by
56�\gn Qa__\$e, C-5
(Name of person acknow edging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced R L, 0 L.
RtEGNENs t�,
Commission No. 1EV4war. oEI\S�oN#GGO2202� ;;
v ? tNY COMnAIS ember 16, 202 to t
•ph '•-N cKP1RES:beo.oublicUndeM1m
Signature of ontractor/ tens I er
STATE OF FLORIDA
COUNTY OF
TheJpyoing instrument was acknowledgeJbefore me
this day of _ 0 4 C \ \ , 201 by
(Name of person acknowledging)
(Signature of Notary ublic- State of Florida)
Personally Known OR P c ,d �e tificat'
Type of Identifipafa`d'=""
pEANNAMARIEGIVENS
ProducedP Av rmuisSION#GG02202,
T ' PIRES: December 16, 2020
Commission N � d dTbruilotaryPu d tars
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SUPERVISOR
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VEGETATION
SEA TURTLE
MANGROVE
COUNjSER� "
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Rev. 1/21014