HomeMy WebLinkAboutBUILDING PERMIT APPLICATION31PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE A& PTED f �
SCANNED Permit Number: 61 D 0 S& Y
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Building Permit Appficet' AUG 2 2 2018
ing and Development Services
"g and Code Regulation Division Pe rm I ttl 11
Virginia Avenue, Fort Pierce FL 34982 a rt m e n t
e: (772) 4tr2-1553 Fax: (772) 462-1578 Commercial l Q. ®u n t r FL
APPLICATION FOR; To Select from dropbox, click arrow at the end- of line Y M,;i o �r
Legal,iDescription: ♦ Vei AC P✓1 K ly Lv4- 5�r1Q S
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Pro pf rty Tax ID #: 3H l� — Cj o �-I ` o c� - I Lot No. 5
site Ilan Name: Block No. U1
Proj ' Name:
Set asks front Back- RightSide:. Left-Side�
R-c m-Ove. -e,r4 s-I-;na5 rcD-' s4S�kw, d a�nfio pl z,
�sk� Urns-(�►� a t� � 151�Cr�m.p rn1��o ro�
HVAC L _1 Gas Tank
Electric El Plumbing
Toth; Sq. R of Construction: /
Cos$ of .Construction: $ 1.),. (b r'1 1
Piping 1 _tShutters 11WindowsfDoors
nklers Elenerator _.goof 12�0 goof pitch
Sq. of First Floor:
Utilities: OSewer 1 t-Septic Building Height: y
Na i e iY1 i e h G t Or
Name: P iC
Company: kDF'i
Address: 1 q 16 < SF�U
Act ress: sip SF �lQ�� ✓
Civil - �f- Diu Cis e. State - �„
Zi (Code: 3 Kct �� _ Fax:
Ph ne No. '7 7a - Yid -(7d 3 N
City: �bo - S-f- Lu('.t State: ��
Zip Code: 3''fq�j Fax: r771-� a'7 735-
Phone No. r% %J- 399 - r-714 -23
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in fee simple Title Holder on next page (if different
ner listed above)
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State or County License- CCC 17�� \p
Ir Y,3�ISke 9T C0DW CU0n IS .%7-59U OrMore, a RE-C9RDED Notfce of Co mme;jcementiS reaujre-d:
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DES 6NE ENGINEER:. _ Not Applicable
MORTGAGE COMPANY-
Not Applicable.
Na ' e:
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Name:
Add1 ess:
Address:
Cityl State:
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City:
State:
Zip: Phone
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Zip: Phone:
FEE �IMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
Not Applicable
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Nang e:
Name:
Address:
Address:
City
City:
Zip:
Phone:
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Zip.:. Pirone:-
OVM0/ CONTRACTOR AFFIDVJT, APPRIcation 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. Lu ie Conte� makes no representation that is granting apermit wiH authorize the permit holder to build thesubject structure
which is in cora#lict with Gray applicable Home owners Association rules, bylaws or arad covenants float may rEst�ictarrohibrt such
strati re. Please consult with your dome Owners Association and review your deed for any restrictions which inay apply.
In coci�sideratior� of the granting of this requested permit, I do hereby agree that Twill, in atl respects, perform thewark
in acc t
dance with the approved plans, the Florida Building Codes and St. Lucie- County Amendments.
The following building permit applications are exempt from undergoing a full concurrencV review: room additions,
acces__ITory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non residential use
WAI4�NING TO OWNER: Your failure to Record Notice of Commencement may result in your paying twice for
imprbvements to your property. A Notice of Commencement most be recorded and posted on the jcibsjte
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.
I I
Signature of O r essee/Contractor as Agent for Owner Signature o€ Contr or/License-Holder
ST/I TE OF FLORIDA� j_ / STATE OF FLORIDA/�
COf jify Of C� (.1/1( � COUNTY OF
I
The forgoing instrument was acknowledged ore me Theft) ing instrument was acknowledged efore .me
thiSIr�_ day of 20 y this May of Gi�t.G�. , 20�y
'C �M �►� i-C tt --eL-f o9ai o
Name of persoft making staterhent Name of pers n ing s tement
Pe l onatly t(nown IOR- Produced identification Personally Known _QR Produced identification
Ty ''e of Identification Type of Identification
P.r�srced Produced
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(Signature of Not U tjiVAq ROU LX (Signature -of o
I' _':��� MY COMMISs ON # FF 160517 ;R C�SNYAN09 PR ULX
Co mission No. fee F�l} 'c MY COMMISSION d�0517
s;• or ," IRES Se e�tSer 16, 2018 Commission N :y
Fbrd�NotarySeroe, v;eom s,,a:n EXPIl ES September 16, 2018
(407 3�W153
„ 8- Flord�NotaryServke,00m
(407)398-0153
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