HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR A:pPeit
N TO BE ACCEPTED '� r l
Date �t5�1\ � Permit Number: `AN tj ' da�i�
RECEIVED
1 OCT 1 X 2018
Building Application
Planning and Development Services ST. Lucie CpwMy, Permitting
Building and Code Regulation Division
23001 Virginia Avenue, Fort Pierce FL 34982
Pho I e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
[PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
IL- ) /'—/ i jo'� e
Legal
Property Tax ID #: 3/3 e 0 2(9 DDa ^ UC®Unf�Lot No.
Site Plan Name: 9115-d Block No.
Project Name: Ae
Setbacks Front _ T I g;ght Side: ,ate^ Left Lk Side: as
olq /P /;fib / // L'/5 S �. 3 ✓�/� � � �� �ti � � ��� GA,�- i��,
Total Sq. Ft of Construct)on:
3 / s/
Costlof Construction;
Shutters Windows/Door
Generator Roof Roof pit
S . Ft. of First Floor: 3 / S
ilities:Sewer Septic Building Height: 0,0
Name _�AzA- z-s/ /0P% D
Address: P/ b ��- �i+�/��i71/v �d�'
Name:
Company:
VA 00
17 AL)f%
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UL016t-i
City: /4 4,i*11ac State:I
Zip Code: 3 �195/ Fax:
Phone No. -7-7 t_ �
Address:
City: R'�f
Zip Code:
Phone No.
E-Mail:
4� 00 �O
ee/LL.&-
7 Z�%
rJt/F_ r519
6116 _ ild%
°Stater
Fax:
U1�-C10t, 0 k ,U 14d7h 6 .
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: I
Ar— 1 Z 53 )
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name: � /f/4 %r'�..�1�t/i/P�A,v.✓
Address: gi=��ifLAao
City:; &ee bege-A t State: /c/
Zip: 13� C 3 ' 9 Phone 42Z--
MORTGAGE COMPANY: _ Not Applicable
Name: w-av 6 r0"16 _
Address: /s 4h �9i//S 5• —rwz In'll, 'y3
City: !.B rs-ron) State:
Zip: U-ftVD. Phone: OV7 '7 htvw
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City:l City:
Zip: Phone: Zip: Phone:
DWNER/ 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:!! ur failure to Record a Notice of Commencement may result in your paying twice for
improvements to yo r'py perty. A Notice of Commencement must be r rded and posted on the jobsite
before the first ins p ctpn. If you intend to obtain financing, consult v�i lender or a attorney before
commencing work,f�r recordiMe voir Notice of Commencement. /
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Signature of 0 e / Lessee/Contractor as Agent for Owner
Signatu of Contract /License Holder
STATE OF FLORIDA
� 4U/'
STATE OF FLORIDA,,,,
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COUNTY OF % tf
COUNTY OF
The fooinginstrument as acknowled beforeme
M
The forgoing instrument w acknowledged efore me
this j'( day � G� 20� by
thisday of (� by
of
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Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced '� D L-
Produced �-
(Signature of Notary blic- State of Florida)
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Rev. 8/2/17