HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED rijk APPLICATION TO BE ACCEPTED `
Or0 mo
Date: Permit Number:
SCANNED
BY
t Lucie Count RECENEp
Building Permit Application 31it os 101%
Planni and Development Services Department
�9 P Permitting
County
euild►n and Code Regulation Division gt Lucie
2300 �rginia Avenue, Fort Pierce FL 34982
Phone : (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER IT APPLICATION FOR:
PfJSED I
Fe
dres
0 IN 1 Y 05 Llc� 2
Legal D
scription:
PropertV Tax ID #: -SAS' 0061'OCC4 Lot No.
Site Pla
i Name: Block No.
Project
ame: tktl
Setbac
s Front Back: Right Side: Left Side:
F
DfTAI _ED DFSCR PTIQN OF 019
�,n
V -i
CON
RllCTN,KN'FpRMATIO
iti
nal work to be pertormed under this permit— check all that apply:
echanical _ Gas Tank —Gas Piping —shutters", Windbws/Doors l
i
_E
ectric _ Plumbing _ Sprinklers _ Generator Az400f Pitch
Total S
. Ft of Construction: Sq. Ft. of First Floor: _ !
Cost of
construction: $ C Utilities: —Sewer —Septic Building Height:
OW:
�E /LESSEE
CONTRA UR:
MC. o c. ,7 VX-Lct ke1.
Name:,.,
Nam
�s:'13lU1
Addr
Company.:
s o' f State: Et
City:
Address:
Zip Clide:
3 q q f(3 Fax:
City: State:
PhonI''
No. ��2 22 q q I O
Zip Code: Fax:
arl:
Phone No
oxi o, o gyez c G 3 yA W � •(0 ni
rat
ee simple Title Holder on next page ( if different `t
E-Mail
in
LroE-
m
he Owner listed above)
State or County License
If value
i f construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENT Go STRO T , l�E NFOR
AT
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: Stater
Zip: Phone
Zip: Phone:
FEESIMPLE 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 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 anbthe� 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 reco.rded and posted on the jobsi;te
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
k
01
S nature of Owner/ Lessee/Contr
r as Agent —for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF►.�,.,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this %4— day of
20A% by
this day of . 20_ by
I
(Name of person acknowledging)
0 0
(Name of person acknowledging)
i
i
(Signature of Notary Public- State
of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced
Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�•�Pav rye ,�
ASHAHNA INGRAM
Commission No. = 2*° *?
Notary P}�hlic - State of Florida
Com,�es Dec
Commission No. (Seal)
y 20, 2018
Commission # FF 777249
i, OF F�.
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