HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �/t�
Date: /— 6 —/9 Permit Number: I LO
•"�."��.�:�. Building Permit Application RECEIVED
Planning and Development Services 1AN 0 9 11119
Building and Code Regulation Division permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. Luc i County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:
Legal Des
Property Tax ID #: d 3- gD,�- o / — —CD Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: BY
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HVAC 01Gas Tank Gas Piping UShutters Windows/Doors
Electric El Plumbing Sprinklers 11 Generator Roof = Roof pitch
Total Sq. Ft of Construction::
Cost of Construction: $ 1 5 —
/ 0�2- C)O
S Ft. of First Floor: _
Utilities:cn Sewer O Septic
Building Height:
OWNER/LESSEE:
yCONTRACTOR;
Name
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Name. %/1 `lrc/J
Address:
Company �i/1!�/,/��[K,,/�P/ ('M5f-
� L crY
City: - ram/ ito State:, /
Zip Code: 3t Vt Fax:
Phone No. 77a Ca0/ -/}i/�/
Address:/ W7 - 7ql/'Q '
rtrt —OR
City: V� - /,E/!/` 'Q
Zip Code: _5y 7 (O Fax:
Phone No. a -
State: lEt-
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E-Mail: / LC w_,5j&t ( g2G/117G(g/`SYUD%,1W
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: ���J�P�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
`CbN8fkUqMLAVVWbRMATION:'
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conliict 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.
Signature of Owner/ Lesse! /Contractor zcAgent for Owner
"Signature of Contractor/License Holder
STATE OF FLORIDA ISTATE
OF FLORIDA
COUNTY OF La Q .
COUNTY OF � , ua
The forgoing instrument was acknowledge before me
The for oing instrument was acknowledged before me
this day of l►Q " 20 by
this day of JOAD 20 IQ by
c)P1,)M Carlvt+-
1�q Un kl e.
m Name of person ing statement
Name of personmaking statement
Personally Known R Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of N ary Pub'c t f I
(Signature of Notar ublic- Statof Florida
.tyx n�•".,, f�'EN YG. JERNIGANr'a..
Commission NO. x°. fin: No[ak� �c-State of Florida
;o2W �eG:• WE ERNIGAJ
Commission No. 1
Notary P - State of
Commission p GG 222208
`•'.?;ornd" My Comm. Expires Sep j1, 2022
o%' Commission p GG 222
`` 'or
•� Bonded through National Notary Assn.
n;?`'` My Comm. Expires Sep 2
`"'••-•"
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ZONING
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COUNTER
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DATE
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COMPLETED
11
Rev.8/2/17