HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE FORA&PPLICATION TO BE ACCEPTED
Date: q Permit Number: y ��
A
8 SCANNED. ItECENEo
2� " r _.. -e^yfV BY
�'�' St Lucie County APR' 2 ,�2019
� • . Itting Department
Building Permit Applicati,�'eCounh-
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 Residential
PERMIT APPLICATION. FOR:
PRtJPOSED IENT LQCATION
Address: ! n C VeA -
Legal Description: ( . / /
Property Tax. ID #: %` ��J 1 7C? A icy dy aC Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
K�.
Aoaitional worK to be pertormea unaer tnis permit cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ Z# % 5'
Sq. Ft. of First Floor:
ities: —Sewer _ Septic
Windows/Doors
Roof Pitch
,
Building Height:
Name 1`' ecc Name:
Address: Y0i cfCLJ y1 , (a A— V r-: 'i Company:
City: F-t: Pfe G'CL State: Address:
i
Zip Code: Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone.No
Fill in fee simple Title Holder on next page ( if differeIpt E-Mail
from the Owner listed above) I State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:' _ Not Applicable MORTGAGE• COMPANY: _ Not Applicable
Name: Name:',.
Address: Address:.,o
City: State: City:,;y+�-y` , ' State:
Zip: Phone- Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
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 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 Flori a Building Codes and St. Lucie County Amendments.
The following building permit applications are exgmpt from undergoing a full concurrency review: r'oom 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 Wur Notice of Commencement.
t
^.-1! Lor-
"'SigTri5ture of.Owne,r./ Lessee/Contractor as Me t for Owner
Signature of Contractor/License Holder
STATE OF FLORID �FLORIDA,,-
COUNTY `M Ct�
COUNTY OF
,OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 17ay of 20i2,by
this day of 20_ by
AJ4AJ let', C &tes
Name of person acknow a ng)
(Name of person acknowledging)
I
natVire of Notary Public- StatJ of Florida)
(Signature of -Notary. Public-, State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identif' a 'on
Type of Identification
Produced
Produced
Commission No. „. ,,,, ($eaJ)IAHNA INGRAM
Commission No. (Seal)
Notary Public - State of Florida
= ° = Fx ' a. 70 7 8
�'%%°I
Commis
ion # FF 177249
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Rev. 7/2014