HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLtti rD FOR APPLICATION TO BE ACCEPTED
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Date: ll 1 �� Permit Number: �1 1 ok
® UdeCOU
I RECEIVED
Building Permit Application JUL 18 -O ';g
Planning and Development Services '
Building and Code Regulation Division ,57, Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phon Ill (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERIV�IT APPLICATION FOR: To Select from dropbox, click arrow at the end of
PROPOSED. IMPROVEMENT LOCATION=:
Addres 1: F
Legal DII scription:
Property Tax ID #: "3y 1 °1 55aJ dCS� 5 -- 644-3 Lot No._
Site Plan Name: Block No.
Project! Name:
Setbalgks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: _ 00
CONSTRUCTION INFORMATION:
A i,tional work to be nerformed under this permit — chec'k all h apply:
E]HVAC E]GasTank ❑Gas Piping _ Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof. 15111 I— Roof pitch
TotJSq. Ft of Construction: 12U6"a 14AM A�o0 S . Ft. of First Floor: ��(� �c���
Cos Iof Construction: $ GS (� Utilities:cn Sewer 0 Septic Building Height: -1 6� ��4Q
OWNER/LESSEE:
CONTRACTOR:
Na 11e � � � b �
Name: O �z
Ad l�� 5 ,G f'/L' Gc�L�/2,/
CompanyL35A/P/�6) l.I11t4,
Tress:
Cit : padscg7'L 7�c,/�'� State:
Zi IlCode: �' �cT� Fax:
Phone No. 77 -�aiJ�
Address: O 13 6> P,?///
17 lZ
City: ✓ 1
Zip Code: �/` Fax:
Phone No. 7 79-
E-Mail:
Stater
E- II ail-
Fillllin fee simple Title Holder on next page ( if different
fr om the Owner listed above)
State or County License: Cc--c,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
N
SUPPLEMENTAL.CONSTRU.CT:I (W , N �LAUUiIN,FORIUTATIO,N:
DESIGNER/ENGINEER: -T— Not Applicable
MORTGAGE COMPANY:. Not Applicable
Name:
Name:
Address: I
Address:
City: I State:
City: State:
Zip: I1 Phone
I
Zip: Phone:
FEE SIM LE TITLE HOLDER: V Not Applicable BONDING COMPANY: Not Applicable
Name: I Name:
Address I Address:
City: i City:
Zip: 11 Phone: Zip: Phone:
I
OWNER/ICONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify thIIIt no work or installation has commenced prior to the issuance of a permit.
St. Lucie Cznty 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 rwhich may apply.
In considetltion of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accorda with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
IIce
The follow hg 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 anoth9r non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improve I�rlents 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
comme work or recordingour Notice of Commencement.
I
Signatu of Owner/ Lessee/Contr r as Agent for Owner
Signature of Contractor/License Holder
STATEJe
OF FLORIDA
STATE OF FLORIDA J
ST L
COUNT Y OF .'�.1���
COUNTY OF
The for ing' st ument was acknowledged before me
Oda
The f oing instrument was acknowledged efore me
this ' of 20�by
this day of 20by
II
II Na e o person irig tatement
Naerson aking sta
rson y o n OR P oduce)ntification
PerOR Pr duced Ice tification
ype o II tif' ation
Tyon a4
Produ ed
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ProL.
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na iure of (] i i 1)NTE
(Si atur,
APO E .
MY COMMISSION( FaF�T�s-2064
Comm .•,=
MY COMMISSION FF9)
Commissi ',•
Februaryel7; 2020
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DATEI
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DATE
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Rev. 8/ /17