HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED {� 1
Date: Permit Number:
`SC
Building Permit Application st��c/e�NFO
ing and Development Services 0 C
ng and Code Regulation Division IO,
Virginia Avenue, Fort Pierce FL 34982
ie: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 6/
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
I PROPOSED IMPROVEMENI.LULAI;IUN: '
Address: W"B 3'j - /t'L zAQ6 LwLA2K La Ro,& -l-e—Ltre r E� Ft 3rf s.
Lei)alDescription: .rA-'-�f AI,4_z-ICLUa IgLactc-5-0
i
Property Tax ID#:-?,V2S- 764 aady 0ae�2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Fri
DETAI
Back: Right Side: Left Side:
OF WORK:,
�t
CONSTRUCTION'.INFORMATION:_:
I
IJHVAC L JGasTank UGasPiping LJShutters
DElectric OPlumbing ❑Sprinklers Generator
,Total Sq. Ft of Construction: 2-70 S Ft. of First Floor:
Cost of Construction: $ f� Utilities:SewerF7I Septic
a- iK 10
]/Windows/Doors
t� Roof = Roof pitch
Building Height:
OWNER/LESSEE:. `
CONTRACTOR, '
Name &Ft%�2Yi 0cd,09AF2z
Name: 0C:ee,4A6<-A 1E«GRKD
Address: 0037 /►'t KttD40LNLA4K- LN
Company: 7 �CGoar RGuMr.�urY PeoA.
City: lDare _5'i Lucre State:.�E&
Zip Code: Fax:
Phone No.-*2 7 2 4efg —(95</
Address: � G*yrxl Fl 1J41
City: Ad.ei LucE 1,State:_j�Fe_
Zip Code: _T!f9S"7 Fax: 772 33G-3324
Phone No. 77z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: fLi �ZAKiJ�C /k/k[L CdM
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENLAW, INFORMATION_:
DESIGNER/ENGINEER:
Name: 2®8.iE2i 4t/DVLrFA
_ Not Applicable
MORTGAGE COMPANY:
Name:
_/Plot Applicable
Address /s7_-,?
Address:
City: 'T7/, V/GL/+GEf
Zip: �2!_r4 Phone 77.m-
Stater
� =65«!
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_✓Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 vour Notice of Commencement.
-:�s
Z��z
S' ture of Agent for Owner
wner/ ssee Contractor as Ag
i ure of ContractotTLIcense Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OFF
COUNTY OF -fie.
The for oing instrument was acknowledged before me
�
The forgoing instru ent was acknowledged before me
this day of �a< 20 lam\ by
this- day of 20.fg by
Q
,4�
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced FL
Produced 4�L QLk,*
(Signature of Notary o[ida-)
,�`�•'',
(Signature of Notary Public- State Florida )
tw•aJ,, LA8N.4PNA INGRAM
Commission No. �o• Notary{9g�1); - 8tato of Florida
f
My Comm. Expires
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Commission No. ..•`Y>0.V ^Gac, LASHt.Se81,VGRAM
• °. �y Public - 8tatc of Florida
Dec 0. 2018
177799
•....
CO
;N a • My Comm. Expires Dec 20, 2018
oe Commi�cin n Fa nen
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Bonded through Nati
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nal Notary Assn. V
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REVIEW
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DATE
RECEIVED
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DATE
COMPLETED
Rev 8/2/17