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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEFi-w Date: SUANNLD Permit Number: _ NW-01'sa RECEIVED Building Permit Application JUN 071018 Planning and Development Services perrnm6t ng Department Building and Code Regulation Division S. Ld9de County 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: Legal Description: 5c.14 24 d 4 a r4P,,4s Property Tax ID #: �� �� 74� %DOS j©o- J Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Name _4 v°f_AV Address:%w"i 3F7% ,qy�°P-P City: �fT , gicd=- Stater Zip Code: Fax: 1Qi > Phone No. � � � 7©�) E-Mail:G�or-4-IR�ovt.� Fill in fee simple7itle Holder on next pace ( if different from the Owner listed above) Name: JC>A PJ Z-. Cf d eD /�-LrC[ CompanyA&At' e1 Ars-6 ref/sue •�/iG�c/��*js� Address: 130 /�?c ✓RA bQ 902 �n City: Stater Zip Code: i7 `F 2 f -�, Fax: 3ps& ' yat�, ^ f uC Phone No 771-, $r T — %yC E-MaiI1JeCA Cv�I f//L•tc/.o;�`jy (t4,vr��f 'f State or County License tf If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. DESIGN ER/ENGINEER:-" _ Not Applicable`"` Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Nameso, Address: City: Zip: Phone: MORTGAGE COMPANY: _ Not Applicable Name:,. Address: City: State: Zip: Phone: BONDING COMPANY: Not Applicable Name: 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 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 a first inspection. If you intend to obtain financing, consult with lender or an attorney before comyriedrinja work or recording; vour Notice of Commencement. Sign ure of OwderrLesW/Contractor as -Agent for Owner S.:ATE, OF FLORIDA COUNTY OF The forgoing instrun-mrit was acknowledged ,before me (Name of p-1,6on acknowledging) r� Vv _ of Notary Public- State of`klorida ) Signature/Of Contractor/Lice e,H older ' STATE OF FLORID COUNTY OF The forgoing instr ent was acknowledged before me this �l day of 20LZ by (Name of pers acknowledging) "turb of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No.: � ,;unu, ASHAHNAINGRAM ,�`PaYwe,,, "(Seal- C mission No. ..,nq, ,.�osPaY"�o'; _ LASIi - � (fie"?I)INGRAM a „ Notary Public - State of Flor - My Comm. Expires Dec 20, 2 da 98 ', * :� ?N . p. Notary Public -State of Florida MY Comm. Exoir"p(Z no _ . �,o�c o� yin uiiasiun F. rr I IQ4 �., "ZOF ih,..` �.nmISSIon..3` FF 177249 REVIEWS : FRONT ;�CjIIIV°mod hrSUrIpER1%I80Ry �sn [ANS VEGIETrFNati nIVIi�VE COUNTER REVIEW REVIEW° REVIEW REVIEW REVIEW" "`REVt1Np DATE RECEIVED DATE` COMPLETED