HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP 1ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
II .
Planni g and Development Services
euildinI�and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phonei (772) 462-1553 Fax: (772) 462-1578
RECEIVED
Building Permit AIppli ation
SEP 12J18
ST. Lucie County, Permitting
Commercial Residential
PER IT APPLICATION FOR:
Addres Q 9 6 f We Sl r�, "ct S+ �oZ
Legal D scription: lo I fi t, oA I
Propert Tax•ID,#: oy, mot% 0-'F, Lot No.
Site Pla Name: Block No.
ProjectName:
Setbac s Front Back: Right Side: Left Side:
/j
I 0 Z. , � 4- w ._, l LP a ivl� '. : TN n n nA A, ► n .SLn _ a A k, w
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Aaaiti Ial work to be perrormea under tnis permit- cnecic an tnat appiy:
—IVechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing' _ Sprinklers _ Generator _ Roof Pitch
Total Sc. Ft of Construction: d Pf Sq. Ft. of First Floor:
Cost of Construction: $ W019 CS'D O Utilities: _ Sewer _ Septic Building Height:
Name's U b Name:
Addre ls: C� 2 u q Wes+ ay)d, 5+ Company:
City: UC ei State n / Address:
Zip Code: � c6 `� Fax: City: State:
Phon I�No. "7 - �l - 3 _7 Zip Code: Fax:
E-Mail *e:0 za: , c e-w% Phone No
Fill in leeisimple Title Holder on next page ( if different E-Mail
from he Owner listed above) State or County License
If value §f construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU'PPON
Ci
INS
• V. ,
DESIGNER/ENG NEER:
Name: '��
Not Applicable
tiW
MORTGAGE COMPANY: _ Not Applicable
Name:
AddressT
Address:
City:Ilt
State:0
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;ihat 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 concurrencyreview: 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
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.
U.A 16k-. {.
5ignat4re,of,"6ywn-iir/ Lessee/Contractor as Agent
Signature of Contractor/License'Holder
STATE OF.FLORID _
M�
STATE OF `FLORIDA
COUNTY OF
2 �� o
COUNTY OF
The for oing instrum nt wa acknowledg efore
w g
The forgoing instrument was acknowledged before me
this day of 2(M by .
T
this day of 20_ by
N
Name of person making statement.
66Name
of person making statement.
Personally n _PR Produced Identification
Personally Known OR Produced Identification
Type of Identific 'Lo n
Type of Identification
Produced
Produced
(Signature of No Public- State of Flori a)
(Signature of Notary Public- State of FloridaVy )
Commission No. (Seal)
Commission No. (Seal)
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