HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO MUST BE COMPLE'i' _U FOR APPLICATION TO BE ACCEPTED
Date: C -J' T14 Permit Number: \q 6e*-6 5'1 W
SCANNED
BY
St. Lucie CoUnt e RECEIVED
Building Permit Application
Planning and Development Services
Building and Code Regulation Division ST. Lurie County, PeYtflIGCI(1q
2300 Virginia Avenue, Fort Pierce FL 34982 - — �`—
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: 5 9 FEB
P R71010,- E ► INPRlJVE ENT Ca?CATIQ
Legal Description:
Property Tax ID #: �3 kd - b Lot No.
Site Plan Name:
Project Name: I 2.t��ped
Setbacks Front Back:
Block No.
Side: i.5 F"tLeft Side: l
ditional worK to be pertormea under trus permit- cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1400 Sq. Ft. of First Floor:
Cost of Construction: $ 31 S%. Utilities: —Sewer _Septic Building Height:
OWN 7R/III E-6SSEE:
CUNT ACi'OR
Name Emisr flt 7- Acin r'Y1Z
Name:
Company:
Address: Ggol L3rcc�.kJtnQ- Ay2tntid,-
City: Fcx+Qfe c - State: EL
Address:
Zip Code: 3 t{•4 51 Fax:
City: State:
Phone No. '?Qf - SQ(o • 33[b0
Zip Code: Fax:
E-Mail:
Phone No
E-Mail
Fill in fee simple Title Holder on next page ( if different
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
1
SUPPLEMENTAL CONSTRUCTION L EN LAW UN
'ORT,ATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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.authocize the permit holder to build the subject structure
which is in conflict with any applicable;Horhe,,C) uners,Assoclation. rules; bylaws;or an cgvenants,that:rpay restrict•oC pr`ahjbit such
structure. Please consult with your Home Owners Association ana 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 witf 'lend'er-or:an'att'or'riey before
commencing work or recgrdfng,your Notice of. Commencement.
)CI
Signature of Owner/ Let/Contractor as Agent for Owner
Signature, of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledgegbefore me
The forgoing instrument was acknowledged before me
'a thist' day of ,i Q rk 20� by
this day of 20_ by
Qss'c�r
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L
Produced
(Signature of Notaryu,6 <205tate of PI&I a�
a° k MYCOMA4ISSION #GGO_?023 (y
(Signature of Notary Public --State of Florida )
�tr°- F_CPIRE Derember 16,'lC�U 1
Commission No.i4'Si .°eF ee II11
onded7tr Y��S�PublicUndernn110m �
Commission No. ' '' `
'(Seal)'
F-•.• ,,
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DATE
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RECEIVED
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DATE
COMPLETED
Rev. 8/2/17