HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J%(,�
Date: Permit Number: 4
RECEIVED
�► . �� JUN I 1 �019
_ Building Permit Application
Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 v�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: UU ' k--5"
Legal Description: -- �A r T"V -� �� �CWe-
Property Tax ID #: 2 70-3 —Oee 25- — z> &-> 0 7
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No._
Block No.
CONSTR+LICTION IN'iFOR�MATION:
itiona wor to a per orme un er t is permit — c ec a t at app y:
_Mechanical _ Gas Tank _Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: -Sal Sq. Ft. of First Floor:!!�:p
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LE=-SSEE:
CfJNi RACTOR;
' r
Name _ i -s
Address: OD!]_ �` S7�i'G
City: /SIP tG
Zip Code Fax:
Phone No.
State
Name: J �.-,. ��g,—
Company:
Address: �13Q9 tilA(I-ee �
iVe-V '
City: ;f t
Zip Code: ,Zqf�.: Fax:
Phone No �77"2)
State:
E-Mail: S �,o
Fill in fee simple Title Holder on next p
from the Owner listed above)
( if eren't,
E-MailAn Le,��� ,k �_ f,
�✓ rl t'a
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. I�/
DESIGNER/ENGINEER:
Applicable,.
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
,MORTGAGE COMPANY: _ Not Applicable
' N a'rt)'e:
Address:
State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Name:_
Address:
Address:
City:
City:_
Zip: Phone:
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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
corr,w*ncing work or recording your Notice of Commencement.
Sig ature of Owner/ see/Contractor as Agent for Owner
Sig ature of Contractor icense Holder
STATE OF FLORIDA
COUNTY OFF
STATE OF FLORIDA
COUNTY OFF
The forgoing instrument was acknowledged before me
this 'll day of 201Z, by
The forgoing instruryTnt was acknowledged before me
this 1\ day of 202- by
Nam"Verson erson making stateme
Personally Known OR Produced Identification
Name of p rson making statement.
Personally Know OR Produced Identification
Type of Identificatio
Produced ••""""�� '' '`�FryAHNq INGRAM
- - Notary Public - State of Florida
•� * v •� My Comm. Expires Dec 20, 2018
Commission # FF 177249
Type of Identification
Produced ..........
."'.. ""'S.
,20* e��,� �nSHAHNA INGRAM
-
- Notar
• . - y Pobiic State of Florida
AA* oP My Comm. Expires
�;°fF4o���� Commissin Dec20, 2098
of Nota -P.lfttil S t (8fr(lat 3iional Notary Assn.
(Signature + L,v, )_
"yy
(Signature of Notary P`tiStte-oF tla1) r_aPionzlNotarygssn.
Commission No. (Seal)
Commission No. (Seal)
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DATE
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RECEIVED
p�`�ll�
0��
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DATE
COMPLETED
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Rev. 8/2/17
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