HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP �ICABLE INFO MUST BE COMPLE'i r6 FOR -APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
-r*J°..«..a"yu"'".'?!'F'7'S vt� 7
RECEIVED
m a..._". Building Permit Applica ion
Planninig and Development Services
JUL 2 4 2018
Building and Code Regulation Division ST. Lucie Cou ty g�rTi(tCing j
2300 Virginia Avenue, Fort Pierce FL 34982
Phone 1- (772) 462-1553 Fax: (772) 462-1578 . Commercial Residential '.
PERMIT APPLICATION FOR: �a a -te- Co I urn n 'I nS`1 u N ((Don
II 1�TZ;2 TNT �c
PRC? OSED Ii�IPRQVEMEN� LOCATION
Addresa Di ( T
Ioml fl �errintinn• -�1[ . C^Yf lril%� ! l .�llI I I LI LOTS
DET [LEI 3 DE5CRIPTION OF WORK: --
t3V11NER%LESS,EE.°
Y
C ' NTRACTC�R
Name
Address:
City:
Zip Ci
PhonlNo.TIQ
E-Mail:
in
i �-, (l }\\ �i
" .-1 �-
Name
Compan.y4
Address: 1 Gr1 'C � VI (11,0
i_mC A- Weerce... State: �L_
d
� �
State: F'
City:
ZipCode: 5Lj' t Fax:
! uur
Phone No 15Fill
E-Mail
l
ifee simple Title Holder on next page ( if different
from
the Owner listed above)
State or County Licen
If vaiueii f construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEf�NST ifiN LE��l INt7RIlllAi'IaN.
. -,.
/ -
DESIGNER ENGINEER: Not Applicable
e
MORTGAGE COMPA Y Not Applib
ocale
Name: i
Address:
)Name:
Address:
City: State:
City: State:I1,
Zip:' 1'
Zip: P e III
III.
FEE SIMPLE TIT , DER: ' _ Not. Applicable BONDING CO ANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application N' 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 foe,
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, cons It with lender or an attorney before
com encin work r re r. ing your Notice of Commencement.
i
Sign u of wner/ Lesse /Contr for as Agent for Owner
Sign e o o r i se olde
ST TE OF FLORIDA
COUNTY OF
ST TE OF FLORIDA
COUNTY OF 'C---
The for oing instrument was acknowledged before me
this ' day of 'Z20 by
The for oing instru nt was acknowledged. before me
this d y of by
��' 7f a.
AJ W
ame of erson ack wledging)
(Nam f rson acknowl d ing )
( ignature of Notary Public- State o Florida)
Personally Known `` .�`�rod�lefc�en ��fi�aan -'
Type of Identification r y. �YY �►�� llii 00�—
Produced _, Commission # GG175422
' January 16, 2022
Commission No. '�;;�;,� Bondedy�ron Notary
(Signature of Notary Public- State of Florida )
Personally Know �� '���'%Q COm#dO�IYion
Type of ldentific GG1;75422
Produced moires: Janua 1ri, 2022
'''�.,�; ��.•��' Bonded thru Aaron Notary
commission No. (Seal)
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DATE
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DATE
COMPLETED
Te—v.7/2014