HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFOMUST BE COIVi,-L:e7ED FOR APPLICATION TO BE ACCEPTED
Date:' 0FN Permit Number: I�7
I
�-rMRECEIVED
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Building Permit Applicatio OCT 092018
Planning and Development Services
ST. Lucie County, Permlttin
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
8
PERMIT APPLICATION FOR: v wog
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Tax ID #: 14 1 33- �M 15 ��'Q ~�J
ame:
Front Back: Right Side: Left Side:
% eN \-\11�� %M 5_(A V4,?y �
Lot No.
Block No.
10ut> ..
Aaaitio'nai worK to ne perrormea unaer tnis permit — cnecK au tnat apply:
_IViechanical Gas Tank )G Gas Piping V% —Shutters _ Windows/Doors
_ E ectric / _ Plumbing _ Sprinklers _Generator _ Roof
Total So. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ��3� e .5 J Utilities: _ Sewer _ Septic Building Height:
Name ;'�-"S:L J:4� '��C.'ti(
Name: ,�--
Add reps ' I%90, lo, pOv W `N��
Company ` "�'1'� � �1� n 0,6kno - _—
City: 4D EF.G '�" — State:V L—
Addr`es�s,:: ,�,%t� {, i `iY11 '�AMZ
Zip Code 9^R5� Fax:
City: � r ® 1&00L Staten—
Phone)) No. '77o� 9)8 �' -�'S 5�
Zip Code:N�5 � Fax:
E-Mail:
Phone No 17a Z) a 35,E
I
Fill in fee simple Title Holder on next page ( if different
E-Mail W � )) i q.�. 3 (aOA '1 DP kKA
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNI
Name:_
Address
R/ENGINEER: 'Not Applicable
City: State:.
Zip: Phone
MORTGAGE COMPANY: _ Not Applica
Name:
Address:
City: State:
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 that'no work or installation has commenced prior to the issuance of a permit.
St. Lucie County mmakes 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 orprhibit,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
k d' u Noti ne of Commencement
commencingWOr Or reCOr In o
i
'Siggnatuie f;�04 / Le_ssee/Contractarwas-Agetl ht=fr5rr iXher�
`Signature -of- R69- 7%ibensei Ider
STATE OF FLORIDA .)wV1'
STATE OF FLORID /� ��
W l �)e
COUNTY OF � L_Yl
COUNTY OF
The foFfoing instru enj w s acknowledg b_ efore me
The fo oing instru t a acknowledge efore me
T day 20 by
this Z day of 20 by
this of
PO b9t4 C
(Name of person acknowledging)
(Name of person acknowled ing )
t
1
gnatf Notary Pu ic- State of Florida ) I!
(SiV
(Si re of Notary Public- State of Florida)
na u
Personally Known f/ OR Produced Identification
1�
Personally Known OR Produced Identification
Type of Identification Jenni L. Adkins
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Type of Identification
Produced Adkins
Produced
o Y PUBLIC
o so NOTARY PUBLIC
—STATE OF LORIDA
Commission No. �Comm1'�G1910
Commission No. �� ESTAT&POLORIDA,
_
s 9�9
Comm# GGt161910
El Expires 1/11/2021
1�a rixpl
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