HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL_: rJ FOR APPLICATION TO BE ACCEPTED '-
Date:- - _-.l'I )_9-Irl)._ _ _ ___Permit_Nun
Planning and Development Services
_Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: "ICU .,F-
Legral Description:,
PropertyTaxlD#:
Site Plan Name:
Project Name:
Setbacks Front
Building Permit
Commercial
KRAXIVE®
JAN 15 2019
04fling Department
St. Lucie Cou ty,- FL
Residential
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Block No. -/
Back: Right Side: Left Side:
M
Aaaaionai worKto oe perrormea unaerinis permit-cnecK all tndL apply:
—Mechanical —Gas
Tank
=Gas Piping _Shutters
—Windows/Doors
Qr—" lecric`.•; •,-P(umbin g
Sprinklers Generator
P
Roof Y �Z Pitch
7otabSq FtdfConstruction
2j �y
Sq. Ft. of First Floor:
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'Cost of Construc`tion:'$'
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Utilities: _Sewer —Septic
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Building Height:
OWN017, ES -SE M
CO TRACTOR:
Name
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Add re s:.
I
;li Cck
Company::
City: i State:_'
Zip Coder Fax:
Phone No. r/�o�- �r'�Lj
Addre`Ss: �✓1�
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City. VCYD >JePc4,
Zip Code:
Phone No '�pp
State: i�
Fax:
X
E-Mail:
Fill in fee simple Title Holder on next page (if different ;
from the Owner listed above)
, E-Mail Afro
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State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUP L M'NTAL LION
10 LIEN NMINFO
ATION:
DESIGNER/.ENGINEER: ;. = ;
Name:
:_ Not Applicable
'
MORTGAGE COMPANY: Not Applicable
—
Name:
Address:`
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOL'DER:,
Name: '''_
._ Not Applicable
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.
f
Signature ner/ Lessee/Contractor as Qent for Owner
Signature of Contractor/License Holder
STATE OF F
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STATE OF FLOD�4
COUNTY OF
COUNTY OFCl>� Arc ash'
The f r g inbefore me
rtwasacknowledged,
this ay 20by
The fp ing ins rumnt was acknowledged before me
this✓day of 20� by
�rar
>Qrs�O,,,>�
(N m person ackno led/ggiing)
(Na f person acknowlee ge
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MARWEAREMESrOa MY COMMISSION@FF2360.95
2 k�
`' - + EXPIRES: October5, 2019
(Signatur If Nota Public- State of Florida )
Personally Known OR Produced Identification
., 011tlA rtrHalvrPobl9; tlMeiwr¢ei£
(Signat r of Notary ublic-
Personally Known OR Produced Identification
Type of IdentificatiPn
Type of Identiflcatio
Produced nti++p YCOMMISSiO IC
Produced
MY COMMISSIONBFF23B495
#FF23
Commission No.+yS�f EXPI($�at)ctober 5, 2019
Commission No. (Seal)
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