HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0
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All APPLICABLE INFO MUST BE COMPLL r-ED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number: ()U2
ECEIVED
Building Permit Applicati n SEP 2 b 2018
Plann, g and Development Services ST• Lode County, Permitting
Buildi. and Code Regulation Division
2300 "rginia Avenue, Fort Pierce FL 34982
Phon : (772) 462-1553 Fax: (772) 462-1578 . Commercial Residential
PERMIT APPLICATION FOR:
T -PAK IS
PROI't7SEQ MPROVEMENT OCATitJN:
Addres l _)nfry <Sctren Lucia County
Legal Dscription:
Prope " Tax ID #: /VUS S O L - uda:-i - V(-)U- fi Lot No._
Site Pla , Name: Block No.
Project ame:
Setbac s Front Back: Right Side: Left Side:
Aaditio�nai
worK to be pertormea unaer tnis permit- cnecK aii that app y:
_M chanical
_ Gas Tank _
Gas Piping _ Shutters
-Windows/Doors
_ El ctric
_ Plumbing
_ Sprinklers _ Generator
_ Roof Pitch
Total Sql
Ft of Construction: v� D i1 sy -rT
Sq. Ft. of First Floor:
Cost of
Iionstruction: $
G
Utilities: _Sewer /Septic
Building Height:
i I RA.REA. 0019R:
Name
Addrehs:
City:
oth ne r
Name .
Company:
Ae%e State:
Address: '
4
City: State:
Zip Code.- ° Fax:
1,
Phone No_11
E-Mail ►'►� :. (' _c 0CD a Gc�
Zip Co
Phone
E-Mail
Fill in f
e: t�9�15- Fax:
o. _-7 7 4f6 f- 3 7-5:'
Olcrhyie 2g4ey"Yi
e simple Title Holder on next page ( if different
from t
e Owner listed above)
State or County-ticerise
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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.
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, 1 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 ur)dergoing a full .concur-rency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and: accessory, rises to anotfie'rnon'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
commencingwork or recordingour Notice of Commencement.
ev.
LII � 'FOR
A7 0
DESIGNE✓1R/ENGI,NE�R:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address::,;,., .��" 'die (e�wgre
c.�e
Address:
City: �-
Zip: �4 fa Phone �7 �.�.��-1��
state: r L
- Z �,sl
City:
Zip: Phone:
state:
FEE SIMPLE TITLE HOLDER:
Name'. - _-• ' `" '
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City: -
Zip: Phone:
Zip: Phone:
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sign ure of Contractor/License Holder
STATE OF FLORIDA
STATE FLORIDA
COUNTY OF
COUNTY ^
The forg�rng instrument was acknowledged before me
The forgoing instru nt was acknowledged before me
this ZJ day of 5 C0 d' , 20,�'by
this jr-day of .S 20/by
Name of person ma ingc�stat�e�ment.
Name of person making statem
Personally Known OR Produced Identification
\Proded
Personally Known OR dentification
Type of Identification
Produced
Type of Identification
Produced
i
(Signature of Notary Public- S to of Florida)
(Signature of Nota