HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP@RED FOR APPLICATION TO BE ACCEPTED
Building Permit Appi
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentia
PERMIT APPLICATION FOR:
Address: It i-1-n .S'f- c-e J�—L ?Iycj�j-1 BY
Legal Description: / J % !3 7 ,Jc L 64 „- dllee-.✓pi d &Ark G(ni V(0 St. Lucie County
Property Tax ID #: /301 ' O rp - C�pd-,6 Lot No.
Site Plan Name: Block No. -
Project Name:
ketbacks Front' Back: Right Side: Left Side:
Aoaitionai worKto oe perrormeo unaertnis permit -cnecK aii tnat apply:
_Mechanical _ Gas Tank Gas Piping Shutters
Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: OzG
Cost of Construction: $ o2-cU0. w
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
O W N ER/LESSEE, =
CONTRACTOR
Name Ja."e.S' 6-a//g C/ifer
Name'
Address: (o.t (/ AIM,),
Company:
City: fir State:
Zip Code: Fax: ..
Phone No: ff4�t- 6-02 - 70Ghx- <:y''
Address: --
City: State:_
Zip Code: Fax:
Phone No
E-Mail: 49,A/• C,6 ,.,
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,-S'RECORDED Notice of Commencement is required.
S RPM M E R TO
L GONSTRU
19 R I LI V K ICA IN
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DESIGNER/ENGINEER: _
Named r' L%PhYvn F
Not Applicable
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MORTGAGE COMPANY: _ Not Applicable
Name:
Address retl
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Sc,l aiubv
Address:
Cit,i�? r_r wovd
Zip: 2 7
PhoneNVa 7
State: �_
-.t ,?9 3
City: State:
Zip: Phone:
FEE SIMPLE TITLE
Name:'
HOLDER: _
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 noh-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 r/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder h
STATVqF FLORIDA
STATE OF FLORIDA
COUNTY OF 5-1-1-t.lC t e
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 1-7 day of .70V-J 20_Pj by
this _ day of 20_ by
act nl)eS' GCI(IQI�y�'
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Id t nti iica,Ltion
Type of Identification
ti
Produced ll�rLt F-
Produced
_ ?_ l/ GUX
(Signature of No ce
(Signature of Notary Public -State of Florida )
4PPY PIi // ELLEN VAUGHN
Commission No. 5�°=State of Floric@pary Public
Commission No. (Seal)
y ,= missionit GGG 270079
° MY -Commission Expires
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COMPLETED
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