HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL INFO MUST BE COMPLETED FMAPPLICATION.TO BE ACCEPTED
Date: Permit Number: I W— M (013
I
RECEIVED
Building Permit Application Nov o .2019
Planning and Development Services SCANNED permitting Department
Building -and Code Regulation Division
BY St. Lucie County
2300 Virginia venue, Fort Pierce FL 34982 .. St LUCI@ .County
Phone: (772) 62-1553 Fax: (772) 462-1578 Commercial Residential
PERMITPLICATION FOR:
Address:
Legal Description::IWW) Rl✓cn 6'srXin.,S. N/T' 0.2 L
roperty Tax ID #: 3 ynZ 03 — ov — dooi r Lot No.
Site Plan Name Block No.
Project Name:
Jr
Setbacks Front `� Back: Right Side: Left Side:
Additional w rk to be pertorrned under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping —Shutters
_ Electric _ Plumbing
�'` _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ S*063 Utilities: —Sewer —Septic
Windows/Doors
_ Roof Pitch
Building Height:
Nan'�g °T 57—e60 AkName:
Add r"" ss: id ��� Company: -
City`01 P R Y'15 State: Address:
p 9 Fax: -77ovZ—g67 113 city: State:
Zi Code: �o7C y
Ph Xil:
No. 7 "oL ' a 8 �f Zip Code: Fax:_
E- 00►9'L6_45Y P, Phone No
Fill fee simple Title Holder on next page (if different 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.
y
DESIGNM
GINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: r_5 !`v R Name:
Address - I vX Address:
City: State: City: State:
Zip:y , / Phone A 12 - 416Y - Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
City:
Zip: I Phone:
BONDING COMPANY: N Not Applicable
Name:
Address:
City:
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 accessoryuses 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
rnmmpnrina wnrlc nr rprnrriino vnur Nntice of Commencement.
of Owner/
?ATE
Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
F FLO�
A/
STATE OF FLORIDA
COUNTY OO
6YI- 0
COUNTY OF
The forgoing'instr
nt was cknowledged6efore me
The forgoing instrument was acknowledged before me
this day
of !' 20 /O by
this day of , 20_ by
I
(Name of
i rAnnowleg��/
(Name of person acknowledging)
(Sigr6tUre of
Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known
OR Produced Identification
Personally Known OR Produced Identification
-Type of lde tification
ProducedT�4
AG tbL .
3•y63- 3-4�
Type of Identification
Commission No�`�7
/� q , . JOSH
$ Notary. P01c,
ELSON
Q�j91i No. (Seal)
/ commbslong
249941
My comm. ezpi
Au9.16. 21122
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