HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLa.._J FOR APPLICATION TO BE ACCEPTED Q1^
Date: Permit Number:
_ _ SCANNED �O
BY �u tio�e
• _ St. Lucie CountyittI . eat
NEM
^�--WBuilding Permit Application 00®
Planning and Development Services Vial,
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential [�
PERMIT APPLICATION FOR:
PROPOSED INPROUEMENT LOGATION:
Address: tG
Legal Description: Qs1rT tZ193,�7 c�gP L=(7' 15
Property Tax ID #: 1 7z e) I � � O �� �� �'—`� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left'Side:
DETAILED DESCRIPTION OF WORK:
t `—cv S ►/L �1J�-k l
Z
., R� P AITI ION:
CONSTRUCTION l.N.F,@
AdclitionalworKtOi3eperrormea, un er this permit - checW all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ indows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 2 COV r Sq. Ft. of First Floor:
Cost of Construction: $ C r Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
E0NTRACTOR:
Name grsXG Lt��� S�l�l�tl-CS _
Addres .Z4 l r✓ �. Sta ��� r�L� Sf
Name:
Company ��.y > keg_
City: 7 l'zr- Stated—
Zip Code: ?�4c(�� Fax:
Address:�r16 S� k �AF—ILL
City: State:Je
Phone No.
Zip Code: O Fax:
E-Mail:
Phone No--,7
Fill in fee simple Title Holder on next page ( if different
E-Mail < f"L A 4ac>r_Q
State or County License Cf1-137��z
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR ON LIEN LAW INFO
MATRON:
DESIGNER/ENGINEER: ' Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/ Less ontractor a gent for Owner
Signature o ontractor/Li nse Hold r
STATE OF FLORIDA
STATE OF, FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrent was acknowledged before me,:
The forgoing instr ent was acknowledged before me
AQ
this kb dayof� { ^ 20j%_ by
'WA/A I%
this day of 2�0X by
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Name of person m ng stateme .
Name of person making atement.
Personally Known OR Produced Identifications
Personally Known OR Produced Identification 1
Type of Identification
Type of Identification
Produced
112iLla"
Produced
4 J i
(Signature of Notary Public- St6be of Florida)
(Signature of Notary Public- Staof Florida )
Commission No. �a S
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Commission No. .���^���A. Lryl�- AN rRotMlorlda�"
�HAHNAINGRAM
Notary P- stale of Florida
%•Notary Tu, .
jA.°^n.= Comm. Expire` Dec 20,cc
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