HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CON.,�.ETED FOR APPLICATION TO BE ACCEPTED cam'
Date: ���� l= Permit Number: /
RECEIVED
• DEC 2 81018
--- - - Building Permit Application Permitting Department
Planning and Development Services St. Lucle,counly
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 %
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential J
PERMIT APPLICATION FOR:
Address: —4
Legal Description:
Property Tax ID N: 6A
Site Plan Name:
Project Name:
Setbacks Front
Side: Left Side:
Lot No.
Block No.
' f-- x I1l)Ajf).A k IL51,J S (JcYu :v4 X 7 0 +v b0 tz e)i e✓ /
," T#X
Additional work to be pertormed under this permit— cnecK all. that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1 8J LO Sq. Ft. of First Floor:
Cost of Construction: $ 1 oCa I Utilities: —Sewer _Septic Building Height:
OWNE-R/LESSEE:
GONTRACTOR:
Name t'jt
Name:
Address:A0 LIN`L 0u41716tii
*-
Company:
City:
Zip Cod77
e: b(4 Q I CI Fax:
Phone No.�2-2-Li
State: H-
Address: w-
City: State:_
T
Zip Code: Fax:
Phone No
1 _`
E-Mail: V-t `t1\Qr 5,4 UC( ec o, t�A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S I IESiTRUI 0ffi!,2Nffl1 EN' LAW NF
"RMATtON:
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 your Notice of Commencement. I
Signa ure of Owner/ Lesse kyntractor as Agent for Owner
Signature of Coijtractor/License Holder
STATE OF FLORIDA t
STATE OF FLORIDA
COUNTY OF Ll is ti,
COUNTY OF
The f ing inst ent was acknowledge before me
The forgoing instrument was acknowledged before me
thise dayof Ct 20 by
1'
this_ day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Ident ' tion
Type of Identification
Produced
Produced
r i
AA L cf�
(Signature of Notary
(Signature of Notary Public -State of Florida)
""" N S. NIELSEN
:..°+w91
�State of F oridaa Notary Public
Commission No.
= ommis l4 GG 207484
Commission No. (Seal)
My Commission Expires
June 12, 2022
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