HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C0I1 ie,
Datel M av
FOR APPLICATION TO BE-ACCEPTEL+`
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Permit Number:
RECEIVED
Planning an'd Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: d
Legal Description:
OCT 3 12018
Building Permit Applic ttonie County, Permitting
Commercial Residential V
St Lucie Cou
Property Tax ID#: 2, Hog - sLo H-oo?.3 --ow-6 Lot No..
Site Plan Name: Block No:
Project Name:
Setbacks 'Front Back; Right Side: Left Side:
r
_ Electric _ Plumbing _ Sprinklers _ Generator
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Total Sq. Ft of Construction: 2ffoo ff Sq. Ft. of First Floor:
Cost of Construction: $ 930, L90 Utilities: _ Sewer _ Septic
Roof SII L Pitch
Building Height:
0 NER I.CS "EE.
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Name PinreA % e- S . P�OPr Ps
Name
Company: ica e.
Address: >�
Address: S C)S F�tvti! �, �5 (= Z7
City: e0�'rt �iiY °"° �fi State:
City: 6?car_ S'j': L'yy stater`
Zip'°Code:13yq512 =Fax: '
Phone No.
Zip Code: 3 �� C6 % Fax:
E-Mail:..
' Phone No -)72,-UO —R5"6 S
E-Mail 0_ vadwo
Fill in fee simple Title Holder on next page ( if different .
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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S�iPPL��l1�NA �pNST!1211211111�GT`ONI;�` LAiNI �-�'+iION.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: =
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
I
_
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: _Not App icable
_
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 Countyy 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
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
commendnR work or recordjog your Notice of Commencement.
Signature'of Owner/ Lessee/ on for as Agent for Owner
Signature of Contractor/Lic cter
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF tic, Ir,
COUNTY OF
The f ing instru nit s acknowledge efore me
this day of 20 by
The oing instr s acknowledge efore me
this day of 20Tby
A
&A ae /e
Name of person making statement.
Nam of person making statement.'
'
Personally Known OR Produced Identification
Personally Known OR Produced Identification Y
Type of Identific ' n
Type of Identificatiftff-
1 Produced
Produced
(Signature of Nota
-
(S gn ture of Notary'Public-State of Florida )
Commission No.
`�.�P`n'r"p'�8.,, KAREN S. NIELSEN
__° ` ;State of clqq da n(Jotary Public
mmis� 1. R IGG 207484
Commission No. o`"�P'''% KARE(��a1)NIELSEN
o�f�°��� My C�jry,n fission Expires
June 12, 2.02.2
;_ ;State of F orida-Notary Public
_ l
:• •= Commission # GG 207484
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June 12,
2022
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DATE
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RECEIVED
DATE .
COMPLETED
ev. 8/2/17