HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-• ,
ALL APPLICABLE INFOMUSTUST BE COMPLcr'cJ FOR
\
Date: " �'�1 p
CATION TO BE ACCEPTED `
SCANNED Permit Number:
BY
Lucie County RECE VIVI ED
Building Permit Application
APR 2 7 2018
Planning and Development Services
Building and Code Regulation Division L
��I Caa;1ty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: To Select fror� dropbox, click arrow at the end of line d
PROPOSED IMPROVEMENT LOCATION: J I- ti�
Address: �6'7 /� ( _hm/t/
//�,� 'It fit -F 0�
Legal Description: S YJ W V►(/1 Q L-r,,OA
PropertyTax ID#: �yt�-(- `7� t - ���) (-��(,�� Lot No. 47
Site Plan Name: I Block No.
Project Name: 2UC4 I
Setbacks Front Back: Right Side: Left Side:
I
DETAILED DESCRIPTION OF WORK: I
-F rc v e e t >+ r��i -� &: c.�� -tb code . (v15t� .2J� ► v -{-�-uo
CONSTRUCTION INFORMATION:
itiona wor to a erorme under tispHq'rmit-c check a apply:
❑HVAC Gas Tank Gas Piping O
Shutters Windows/Doors
Electric Plumbing Srinklers Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor: 1&0-7
Cost of Construction: $ :y&60' I Litilities:Sewer Septic Building Height: r
OWNERAESSEE:
CONTRACTOR:
Name (VI
Address: -J� r- /
City: r-f �T State:
Zip Code: Fax:
Phone No. �`.� - � -
Name: UC
Company: ir
ear
Address: 35-/( 5E,((_
City: f'"1/�, State:
Zip Code: J� 4q / Fax:-? 7,;2 28 7 -00
Phone No.?� 02qq
E-Mail:
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County Lic e,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requifd,: ;
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applica
Name: _
Address:
City: _
Zip:
State:
MORTGAGE COMPANY:
Name:
Address:
City:
Phone: I I Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applica
_ Not Applicable
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 As ociation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Associ tion 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 Build�ng Codes and St. Lucie County Amendments.
The following building permit applications are exempt frpm undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, sig I s, 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 C mmencement must be recorded and posted on the jobsite
before the first inspection. If you intend to ob ain financing, consult with lender or an attorney before
commencingwork or recordingour Notice of Commencement.
s
_ Signature of wner/ Le se /Agent Sig ature of Contra or/License Holder
STATE OF FLORIDA STATE OF FLOTa&o
CO COUNTY OF �� UNTY OF.
The forgoing instrument was acknowledged before m� The forgoing instrum nt was acknowledged before me
this _ day of 20 �by this , day of ►'CJr 20 (5K� by
MARv V//vcE/\17-- r
(Name of pershn acknowledging) (Name of per o acknowledging )
0
2Q6w t
(Signature of No ary Pub 'c- State of Florida) I (Signatur of Notary Public- State o Flori )
Personally Known ✓ OR Produced Identificatio Personally Known OR Produced Identification
Type of Identification Produced r, r - Type of Identification Produced
Commission NoJzFq� N� ' I) omm sion No. _ Q� 7Q�
i Notary �bu01k t Im 1 R na ECCA RESTIFO
7 11219 - oipao Commlulon I FF 0096MY COMMISSION # GG91 t;63
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Bonded trough NIIWW Notary A- ^
Revised 07/15/2014
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