HomeMy WebLinkAboutBUILDING PERMIT APPLICATION7
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: rs -c-�)-9 - I Permit Number: O I
St LUCY
Buildi
RECEIVED
Permit Application MAY 9. a 2018
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 _
PERMIT APPLICATION FOR: Go,
PROPOSED UPROVEMENT LOCATION;'
Address: I unnwyw, w"
Legal Description: �kw I &w- v :6ov.
! wL
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
DETAILED DESCRIPTION OF WORK:'.
� and
°J �� �c
Left Side:
ST. Lucie Count , Permittin
Residential
Lot No.
Block No.
U%J
Li
CONSTRUCTION INFORMATION:
itiona wor to e e orme under this permit- check all that apply:
EjHVAC Gas Tank ❑Gals Piping _ Shutters Windows/Doors
Electric Plumbing OS rinklers Generator Roof Roof pitch
y{
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ n—R— ` Utilities: 0 Sewer 0Septic Building Height:
I
OWNER/LESSEE:
CONTRACTOR:'
Name LrNo-t- (S.
Name: ,e
Address: ',__� 9 ( N k-0 dN
Company: --
City: G-k ('R C t+_k State: _
Address
Zip Code: Fax:
Phone No. � � a� � 'j�o a � a %�'
City: 'tPC_rrQ
Zip Code:
MState:
Fax: L 1� l QLQ1a-
E-Mail:
Phone No.
E-Mail: b
t�j}�
i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
I
State or County License:
IT value or construction is :�ZSUU or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN, LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State: I
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: T Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: I Address:
City: 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 piior 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, sigIns, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record aI 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 obiain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for
Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Lut,i,u
COUNTY OF
The forgoing instrument was acknowledged before
a
The forgoing instrument was acknowledged before me
this c7t day of �>r►/ ON 2011 by
this � day of Med 2018' by
��ake �olvy�Lll
Make Cowden
Name of person making statement
Name of person making statement
Personally Known �_ OR Produced Identificatio
i
Personally Known 4 OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
*4I& 0A
(Signature of Notary
- of Florida I
(Signature of Notarif
1311h1ir-Fas '
:;:. NICHO� AP®NTE
�^"';�' NICHOLE APONTE
�
Commission No.
•: MY CO X ION #
FF963031
Commission No.
'•c COMMI�§�i FF963031
�.
•','?aRoi� EXPIRES May 04,
2020
�p�;
'•'.Z ovti�!.'`�, EXPIRES May 04, 2020
14C7i398-0'53 FloridallofarySarviccl.com
14C7)398-0'53 norWNolarySorvica.com
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Rev. 8/2/17