HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr-
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All APPLICABLE INFO MUST BE C(
Date: '
FOR APPLICATION TO BE ACCEPTED
Planning and 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:
Permit Number
)�� II- 0_' 3 0
RECEIVED
Building Permit Aii0icatio0ov 16 2018
Commercial.
Permitting Department
St. Lucie Co*ty, FL
Address: 10M /�lR 'S �-.e n,e.. SCANNED
Legal Description: 13Y
St Lucle County
Property Tax ID #: 033 Z Z - So !�- oNo - QOd -41 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: ��, u Right Side: 02 3 Left Side: e —
_ Windows/Doors
Elii ctric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ®®30y Sq. Ft. of First Floor:
Cost of Construction: $ �OQc�.y� Utilities: —Sewer —Septic Building Height:
OWNER/LsE:
NO cTOR.
Name 7Sv : �(^ C •e
Address: 702t) G�'iK ' �5�ootc� �2
Name:5C.o"
Company: t '�- ��1 ��
City: 64J PAKs4e State: rl
Zip Code: YCp Fax`: /
Phone No. �-F •
Address: S. :..vth 4K IjvA4C
City: State: 1
Zip Code: Fax:
Phone No 2 - 70IR -ye$ g.S
6C.Z-e-uyt,tyA q7 $c„y►,nJ/.
E-Mail 1
Fill in fie
from the
simple Title Holder on next page (if different "`E-Mail
Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTA Ci�NSTR
Ia !I'E W I�NFORMAT ON'
DESIGNER/ENGINFiEr
Name: � �4•.�2 17p
Not Applicable
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MORTGAGE COMPANY:
Name:
Not Applicable
Address:. d �1 �� -
Address:
City:
State:
City:•• '' ' " �` ' State:
Zip: � Phone O
—7 7b
Zip: Phone:
r
FEE SIMPLE TITLE HOLDER:
Applicable
BONDING COMPANY:
Applicable
Name: • ' � �•-'`'
_=Not
i
Name:
_Not
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
improvements to your property. A Notice of Commencement must be ded and posted on the jobsite
before the first ' ction. If you intend to obtain financing, consu it ender or an attorney before
commencin or recordingour No mencemen
Rev.
ignature of Owner/.Lessee/Contractor as Agen
ignature.of Contractor/License Holder
�
STATE.OF,FLORID
STATE OF FLORI
? zw 2
COUNTY OF
COUNTY OF
a��g
acknowledged
The for ,going instrum nt was acknowledged efor
��P'I%'
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me �
The for oing instrum n was acknowledge efore
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m m
this day of ,
this day of J`�i% 20% by ;�;�"•"'�do�_
Name of person making statement.
Name of person making tatement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type df Identification
Type of Identification
I
Produced
Produced
" 1
(Signature of o aryPu lic- State of Florida)
(Signature of N t Public- State of Florida )
Commission No.. ' (Seal)'
Commission No. (Seal)
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