HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
All APPLICABLE INFO MUST BE C' PLETE61FORAPPLICATION TO BE ACCEP_.
Date: % C)' Permit Num
I _ Building Permit Appli
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone' (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: A-
S) a - 03
rD
-OCT 1171018
JFMitting Department
St. Lucie County,. FL
Residential
Legal Description: Property Tax ID #: w z/0 - 60v) Lot No.
Site Plan Name: Block No.
I
Project Name:
Setbacks Front_ Back: Z'`a -h Right Side: '� + Left Side:
DE�TAI'LED DE�SCR�I�PTION iJF WORK.
/2 1 X �ayc�}+i- Z! (L—��/ J-1
�i� .17 _ � . -t I '1/ ` -. t ... t / -! G1 A i1 7 s 1 / �. ! .. td
work to be pertormed under this permit - cnecK aii tnat a
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric ` _ Plumbing _ Sprinklers _ Generator
Total Sqi Ft of Construction: '��'cf�p Sq. Ft. of First Floor:
oy .
Cost of Construction: $ --isAbI9 Utilities: —Sewer —Septic
i
Name L "6-ZteF 6 �A /A
Address: Yd1d-,vJx��rSrGD v1__
City: 27 8 2=_ State:/Z
Zip Code: 3 y2 3115-' Fax:
Phone'No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) .
Windows/Doors
Roof Pitch
Building Height:
Name: / . G
Company: G
Address: by
City: - State:�L
Zip Code: Zj!J/ g 4'2 Fax:
Phone No 2- v
E-Mail L'
State or County License 2
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLE AL N CtJNSTR+UCT{ • !EN LA
IN
�CJRMATIC�
DESIGNER/ENGINEER: A = _ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name ti r `' . ry .r'
Name:
Address: i
Address:
City: }; i State:
City:
State:
Zip: "' - Phone
Zip: Phone:
FEE= 3MPLE TITLE`HOLDER:. + Not Applicable
BONDING COMPANY:
Not Applicable
Name: {..`,j, ti ; , ., ._ s
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 anotheF 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 re din . our otce of Commencement. .
Signature of Owner/ Lessee/Con ctor as Agent for Owner_'
Signatu a of Contractor/License er
.STATE OF FLOBIDA
STATE OF FLORIQA
COUNTYOF
COUNTYOF
The fp going instrument was acknowledgedi-before me.
1'� 6C�
The forgoing instru_Tent was acknowledged before me
% gt-r
this day of 20_`, by
this 5 day of 20B by
Name of person making statement.
Name of person making s atement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L L
Producedall
,g—
(Signature of Notary Pub' -State of Florida)
(Signature of No StotarAw);6022023
RIE GIVENS
Commission No:� DE �ON#6' 022023
_? EXPIRES: December 16, 2020
Commission No. " edThruNotaryP 6gj�lerwritarft
�
MY CO D Ce r 16, 2020
EXPIRES: a m y,. ndent,61816
p Eon e
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