HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Dat�: ` Al Permit Number:
RECelvep
Building Permit Application OCT 1 1 zov
Planning and Development Services Permlttln
euild'ng and Code Regulation Division St. Lucie County t
2300�Virginia Avenue, Fort Pierce FL 34982 County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential t>_
PERMIT APPLICATION FOR:
Add
A t-t Loy 15 Dip),
Legal Description: SPDX's� t licas CUcrn�cy f o V
Propeity!Tax ID#: 130l—l�l-�0ooI-O0p--
Lot No.
Site Plan�Name: Block No.
Project Name: 9Gfiiooki%n67 I,,Io6ILt: 4iOM(' -7 IoC4tV-V Ai- 5eAy)isN L+1kr
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIP.TIONOFWRK
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AddMona l worKto brtormed undertnls permit—cnecK an apply:
�HVAC flGasTank []Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof 2/z Roof pitch
Total S Iq. Ft of Construction: I U� Z-(o W S . Ft. of First Floor:
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Cost of Construction: $ . Utilities: _ Sewer 11 Septic Building Height: 1
f
011UNER%LESSEE i tz 35 r
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'CONTRACTOR
Name
'Vi� A✓1 Vme5kfpS
Name:
'5 L®u I� blo(3 p
Company:
Address':
City:
Address:
State:
Zip Co
e; � q 6jq Fax:
City: State:
Phone
Mg. /3 301 - y 4 n
Zip Code: Fax:
E-Mail
Phone No.
Title Holder on next page ( if different
Fill in fee;simple
E-Mail:
from the
Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S;UPPLEMENTAL`CONSTRUCTION LIEN LAIN INFORMATION
_,.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City, State:
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 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, 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
im ovements to your p o erty. A Notice of Commencement must be recorded and posted on the jobsite
b re the first inspecti n. If you intend to obtain financing, consult with lender or an attorney before
c mrrtencing work or re o ding ice of Commencement.
S' a,ture of Owner/ L ssee/ ntra for as A t for Owner
Signature of contractor/License Holder
ATE.OF FLORI A
STATE OF FLORIDA
U,NTY OF (_u CJ P.
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of b c f-C "' 20 Ig by
this day of 20_ by
�an�%vn1G
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification Y
Personally Known OR Produced Identification
Type'of Identification
Type of Identification
Producedlark,:0. (3cofiSZ
Produced
o oIf Florida)
(Signature of Notary Public- State of Florida
r(sig'at
No.•; (S�61J R1WARSHAW
Commission No. (Seal)
Notary Public -State of Florida
Commission # GG 187062
My Comm. Expires Feb 18,2022
on roug
a iona Notary Assn.
REVIEWS
FRONT
E PLANS
VEGETATION
SEATURTLE
MANGROVE
N
COUNTER
REVIEW
REVIEW RE W
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17