HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMi=L-ri ED FOR APPLICATION TO BE ACCEPTED �1
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Date: i i 1 cr;L Permit Number:
IVE®
Building Permit Applica ion NOV 21 2018
Planning and Development Services Perm((n9 �epalrtment
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie OuntY� FL
Phone: (772) 462-1553 Fax: (772) 462-1578 COn' merd,al Residentia —
PERMIT APPLICATION FOR: G�� P-0 � �LHN F
I Legal Description:
Property Tax ID #:
Site Plan Name:
I -
Project Name:
Setbacks Front
low- � gwIMANINK?�11MI MIN
Back: Right Side: Left Side:
Lot No.
Block No.7=Fji
Additional work,to be pertormed under tnis,permit — check all tnat appi.y:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing —Sprinklers _ Generator _ Roof Pitch
Total SgJFt of Construction`c Sq: Ft. of First Floor. ;
Cost of Construction: $ `'IuUIJ•� Utilities: _ Sewer _ Septic Building Height: '
QWN'ER/LE=-S>E :
CONTRA dR;
Nam . L ,I
Name:
Company: Co
Address: ) L 1 C
Address: CN
City: State:
Zip Code: L' Fax:
Phone No, '�—
City:- -- f2lU .D State:
Zip Code: �Fax: --
Phone Noll l �-," � c- —4430-
E-Mail• ( IZI� . 1 �c�
Fill in fie simple Title Holder on next page ( if different
i
from the Owner listed above)
E-Mail j ou 0,-A ae
State or County License ri
IIf value of construction is 2500 or more,.a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:, _ Not Applicable
MORTGAGE COMPANY: :NotApplicable
Name: ,} ; :.3.,
Name:
;:AAddress
`
_ {
Address:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE H.OLD.ER:_= Not Applicable
BONDING COMPANY: Not Applicable
_
'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 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 recorded and posted on th to
before the first inspection. If you intend to obtain financing, consult with lender or an attorne
commencing work or recording our Notice of Commencement.
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Signature of caner/ Lessee'C�n' aEtoras�'A`ge • _y
Sig, �o caLicense Holder �o 0
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STATE OF FLORIDA
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STATE OF FLORIDA d ��
COUNTY OF aaa
COUNTY OF < w Z
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The forgoing instrument was acknowledge bef a
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The fo going instrument was acknowledged of rn w
this day of 1/ • , 20 f b Z
this day of lY . 20b
SELO
Name of person making statement.
Name of person making statement. Z WT=
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Personally Known OR Produced Identi 013-1
Person own OR Produced Identification
Type of l en ' is ion ,<�•.;�
t 0-
' '"'' `""
Type of Identi ' a on Q
Produced
Produced t .�`
of
(Signature of Notary u lic- State of Florida U U
(Signature o No Public- State of Florida
Commission No. (Seal)
Commission No. (Seal)
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DATE
i
RECEIVED
` 9�
DATE
COMPLETED
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Re—v.8/2/17