HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST
Date:
NW
MPLETED FOR APPLICATION TO BE ACCEPTED Q
Permit Number:
SCAN, NED RECEIVED
BY
LueW Co��fs j MAY 08 2018
Building Permit Application pemllttinaD. a
Planning and Development Services P
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
St. Lucie �ment
County
Residential
PERMIT APPLICATION FOR: To Select from dropbox. click arrow at the end of line 1
Address: 1040
Legal Description!
Property Tax ID #:
Site Plan Name
Project Name:
Setbacks Front
i
Back: 0,dlRight S
'O
0 =1 Lb-E H (o2 `T70-
Left Side:
11HVAC ❑ Gas Tank Gas Piping 1-1 Shutters
❑ Electric ❑ Plumbing Sprinklers ❑ Generator
Total Sq. Ft of Construction: S . Ft. of First Floor: _
Cost of Construction: $ ! , (P� Uti6ties:n Sewer Septic
Name, S0,e- 1
City: n1State: E
Zip CodeNF!�gL 2/ Fax:
Phone No.�— o lu
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No._
Block No.
❑ Windows/Doors
E]Roof Roof pitch
Building Height:
Company: Pi`tiy4Lerr EV4
Address: 3r).4o SL slgk. _ 3f %''F_a _
City: ����IItc � State:.IF(
�.�
Zip Code: ' Fax:
Phone o�'�1 `o
E-Mail: ff —
_ 1�4lt���J4i21Lf\. C:BiYI
State or County License: �52L ko t) tq
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I _
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�aLNfEN CiNS tRUCT(CN LINE{ CNtRIUTATIa�V� �E;
DESIGNER/ENGINEER:' _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State, ! City: State:
Zip: Phone I Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: I City:
Zip: Phone: Zip: Phone:
I
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 Associatioh 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 Commencem�nt ust be recorded and posted.on the jobsite
before he first inspection. If you intend to obtain financinnsult with lender or an attorney before
com ncin work o recordin our Notice of Commence
Signature Owng / Lessee/Contractor as Agent for Owne
Si n t re o o4ractor/License Holder
STATE OF FLOf�A,� �, `�
COUNTY OF 1 I 1 f•�� t o
I
STATE OF FLORA
COUNTY OF 11 �!V-dt`14
The for g instrument was acknowledged before me
thi ! of ` 20�by
i
The forg�trg instru ent was acknowledge before me
this ay of ( 20< by
""ame`of perso `makt`ng;'staternent I
Persona ly Known OR Produced ld ntification
Name ofperrs6n' taking state�e`n:`
Personals KhbWR "' OR -Produced Identification
Type of Identification !
Type of Identification
Produced
Produced
(Signature of Notary Public- Snature
V L. HADDAQ.�
Commission N( ISSION#GG0093
ES:JulyB 2020�:Thru
Public Underwriters
Mimi
3C
of Notary Public- St
mission No.
�... BEV L. HADDAD
QMMISSION#GG009
`� ��EXPIRES;July6,2020
''•� ° ;; °• Notary Public Undenv
6
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DATE
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COMPLETED
Rev. 8/2/17
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