HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONIII �
All APPLICABLE INFO MUST BE COMFCci ED FOR APPLICATION TO BE ACCEPTED
Date'Ili (• �-� � Permit Number: 07, 0�
ED
Plan ii mg and Development Services
Building and Code Regulation Division
230(, Virginia Avenue, Fort Pierce FL 34982
Phof e: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
BY
st. Lude County RECEIVED
RE
Building Permit Applic tion .JIJL �, 9 2018
,'Permitting Department
Commercial i� nt 'Icie. �Unty FL
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Addr ss: 1 lZa �
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Legal Description:
�v ;,4/ fJ*lg
34
J64 /%
Prop' rty Tax ID #: Lot No.
Site lPlan Name: �/ 0 t 11.5 Block No. Z
Project Name: p1
Set 'acks Front 1/ Back: I / Right Side: i/ Left Side: V'
AdalIitionai worK to be perrormea unaer tnis permit- cnecK aii tnat appiy:
l Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Roof 3 �/ Pitch
Tot Sq. Ft of Construction: ®� Sq. Ft. of First Floor:
Cost of Construction: $ 1549e>eg e-J Utilities: _ Sewer _ Septic Building Height:
OWNER/LE=�SSEE�:
C«CNT�RAC*�T®R:
Name • Czi�/ f0"y— 61/
Name: �/5 /y' -��� ✓�i<,iy.�
Address: /Izv /74/4
��`' T�c� ' �� �i �✓�
Company:Ji
Ci
Z�Ip
Phone
y: -;/ ! State:�'Y--
Code: . '2• Fax:
No.`77Z . G7�. G-/ 7
Address: : Z(/ /✓v+/
City: S �— State:
Zip Code: � �'Y �w1 Fax:
Phone No 75414 2-3 4(- -0��7`
E,IMail:
Z.; (o, G-zert/,
F�,l
from
in fee simple Title Holder on next page ( if different
the Owner listed above)
E-Mail
State or County License e-: :�: / 3`3 0957i
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. { 0 Y Y1 j
DESIGNER/ENGINEER:
Name:
—Not Applicable
MORTGAGE COMPANY: Not Applicable
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.
I,
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
,I
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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sign to of Cho r --tor/License Holder
STATE OF FLORIDA
COUNTY OF -54
STATE OF FLORIDA
COUNTY
OF p�l�Ci=
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
this day of—`^�t/� 20� by
this day of JAL( /�f 20 !e by
Name of person making statement.
Name df person making statement.
Personally Known OR Produced Identification
Personally Known_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
RE•LOUIS
(Signature of Notary P. - t6l0ftibn # FF96417
(Signature of Notary Pub' ,WIar %gi0(1
Commission No. 's`° Expire : February 24, 2020
;s.... � Notary
= =Expires: February 24, 20`�'
Commission No. ='"�1
� No:t�
�, Bond Aaron
,.�� Boitl�\ $� ;
,� Aaron
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DATE
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DATE
COMPLETED
,
Rev. 8/2/17