HomeMy WebLinkAboutBUILDING PERMIT APPLICATION_a.
All APPLICABLE INFO MUST BE COMP ETED FOR APPLICATION TO BE ACCEPTEDIM
Date Permit Number:
RECEIVED
Building Qermil.LpDplication
OCT 0 5 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 . Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
[PZR, 0 =0@ S 0 fi� 4 "1 kil 11 111
Address: 7C_W 6'q101eA'-y Z"
f
Legal Description: Z4y 44eale,,,5 - F-Y- Rkee_ e 130f 41�. &pg� 7
Property Tax ID #: Aaw,2311 - 61"0/ _006'C- 000- a Lot No. 17 r' le
Site Plan Name: _C"OL-< Block No.
Project Name: 4e"*,4 /49 4A ;JA91
Setbacks Front Back: Right Side: Left Side: 00
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al W ART11511,111 � =F(ORM:
Additional work to be pertormed underthispermit
—Mechanical — Gas Tank Gas Piping
Electric — Plumbing Sprinklers
I
Total Sq. Ft of Construction: sc
Cost of Construction:$ Utilities:
N a rn e J-Cft n r, Ae ve,
Address: 90g!) Say G4eele_q5 Z-i
City: F94 R-Aire-e- State: jLe'
Zip Code: Fax: halc
Phone No. 772 - A?-/- W.)'
E-Mail: A'-'Ievelseo
w Fill in fee simple Title Holder on next page if different
from the Owner listed above)
I
If value of construction is 2500 or more, a RECORDED Notice of Con
PPL M NT L C+�NS RU
ICl 1! �N UV I
':'t*)R ; ATIO
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
A; dress:
City:"Stey:
Zip: Phone
� _ 7 q _LJ
State:
Zlp: Phone:
FEE SIMPLE TITLEHOLDER:
_ 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 that-no'work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes,n'o 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 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 vour Notice of Commencement.
ure of Owner/ Lessee/Contractor as Agent for Owner I Signature of. Contractor/License Holder
STAfiE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sk LUCK COUNTY OF
The forgoing instrument was acknowledged before me
this � day of CX.iO��� 20� by
e W� Ce � ky(l VAS,
(Name of person acknowledging)
(S nature of Ndtary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.&_Z_? g� '�T �'�ofFbrf+
Faftwa
MY COMMIS"M 02222 25e5e1
The forgoing instrument was acknowledged before me
this day of 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
ission No. . . (Seal) .
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DATE
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DATE
COMPLETED
Rev. 7/2014