HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COnnrLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
13Y
s .
Building Permit Application Julv 122018
Planning and Development Services Permitting D
Building and Code Regulation Division St. Lucie � artment
2300 Virginia Avenue, Fort Pierce FL 34982 I/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION F
P. • •' 0
Address: —1 `i`{ 1\orA'*-J i XAO< Ci r \AY-t S`I W Li -e-
►
Legal Description: E-A,Il.e `lt(..4 r�-� a4 SAORV1 4 VAR b rD-, R6IJ Lo-
Property Tax ID #: 3y aLk ` i oa - cao-14 Uoo - 5- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
3e rek-F v ncR e! l rr� e,r► P.
Aaaitionai worK to oe perrormea under tnis'permit - check all tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator ✓oof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: �000
Cost of Construction�,2o QQ Utilities: —Sewer _Septic Building Height:
OW�01 R/LE�SSE 0:
INNTRACT®R.;
Name �Th�-te i\. \4enJ\ft
Address - qglk '\'kofne& \ A1K Q,.-
Name:VdAM t
Company:
City: Stater
Zip Code: 3-4%3 Fax:
Phone No. 1�6'`� QA0 v1\ e6
Address:
City: Q4 bA uC\. e- Stater
Zip Code: 3kq-S37 Fax:
Phone No "1'79 060 -15ro�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail S'wr vLk- iaa n Q U4-x
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S PPLEM �NTAI: CD kSTRU� IQN LIEN LAUV I "FARM
itON:
DESIGNER/ENGINEER: - — Not Applicable
MORTGAGE COMPANY: Not Applicable
,f
t
Name: y'�t�am'e
-
Address:
Address:
City: State: :; , {
Cityr.n f, State:
'Zip:
Zip: Phone
Phone:
FEE SIMPLE TITLEHOLDER: — Not Applicable
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
commencing work or recording your Notice of, Commencement.
l�
Signature of Owner/ Less ZD0MC11W1as Agent for Owner
Signature of Contractor/Lic se Ho
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF tt
COUNTY OF SNAIL�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledge before me
this 3L day of 20A by
this � day of by
(Name of person acknowledging)
4VASI�
(Name of person acknowledging )
ignature of Notary Public- ate of Florida)
(Signs re of Notary Public- State 8AFIcirida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
T e of.ldentification ��:.•�s�.�.:�� _ _
Type �_^Type
Produced `'jO1j' _ �"
.` KYPI�p LASHAHNA INGRAM
of Identificatio
=P'roduced LA5H.4HNA INGRAM
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Notary Public State of Flow?
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1� , !vu,ary Public _ S
_ p ,= NI C Mate of Floritla
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Commission No. N ° Seal �• Expires Dec
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Commission No. a: (-Seal') Dec 20, 20-1
.� CommissionE
�ornmission # FF 1772
FF.o," FF 177249
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 712014