HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date :• \ b SGANNED Permit Number:
BY
S4. Lus C®unti RECEIVED
�l Building Permit Application AUG o 3 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Perm ttino
2300!Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Addre l s: k a -+ o QW1 �Aay_ \yl'2,'Q.. Cep ` t'CTAW) C
Legal Description:
Property Tax ID #: 1_14412G Q 3 'WH Wo L Lot No.
Site Plan Name: ` Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
inskl l h-e-uj �®41 &,ya 90 -0 ko•t m9p
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A00monai worK to oe errormea unaer finis permit— cnecK all apply:
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IVAC _ Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Mlectric 0 Plumbing Sprinklers E] Generator ® Roof �cs'l � Roof pitch
Totalsi Ft of Construction: N000 S . Ft. of First Floor:
I 1
Cost of Construction: $ Sr 2 Ou Utilities: _ Sewer 0 Septic Building Height:
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Name
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Name: P, Q f�`1` T • ��Z
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Addres§:
Company: 12-co4on a�/Yi'►S
Y1 ` 2_ State: (� k4
City:
Address: ;:20 -1
Zip Code:
"SIB q Fax:
City: SOU .Oie*_ State._Y--1,
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Phone
E-Mai Ij
Zip Code: Fax:
Phone _
IN
Fill in fie
from the
E-Mail: ir1,l $
State or County License:
simple Title Holder on next page (if different
Owner listed above)
It value t construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
I
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Na
e:
Name:
ress:
State:
Ad
Citj
Address:
City: State:
Zip1
Phone
Zip: Phone:
FEE
SIMPLE TITLEHOLDER: —Not Applicable
BONDING COMPANY: Not Applicable
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Name:
Name:
Adtlress:
Address:
City:
City:
Phone:
Zip: Phone:
Zip-'
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I Ify 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
structuure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
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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 f llowing 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
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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
befoll���e the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comrhencing work or cwording your Notice of Commencement.
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Signatur
of Owner/ Lessee/Contractor ent fo4gwfier
Signature of ntractor/License er
�AT#OF
COUNTY
FLORIDA
OF— ^
TE OF FLORID
COUNTY OF
The Ifor�Vg
instrument was acknowledged before me
The forging instrument was acknowledged before me
this
day of kv 016I~ 20_M by
this S day of �5 , 204 by
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�ivar UV"rI v�ez
Name of person king statement
Name of person�tng statement
Personally
Known OR Produced Identification
Personally Known V OR Produced Identification
Type
of Identification
Type of Identification
Produced
Produced
(Sig
ature of Notary Public- S of Florida)
(Signature of Notary Public ate of Florida )
Co m
ission No.
M. GQhZALEZ°�
mission No. Seal'SAMIRA
h� otary Public -5tate of Flo;
Ri a Commisslon� GG 19731
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DATE
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RECEIVED
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DATE
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COMPLETED6,
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Rev. 8, 17