HomeMy WebLinkAboutBUILDING PERMIT APPLICATION9
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l�d'T �� 1 Permit Number:
I -- RECEIVED
JAN 2 41019 -00
Building Permit Application St y�Rr
Planning and Development Services PPrmltting Department �(yC' % 40
St. Lude County 0 C'
Building and Code RegulatibnDivision`• pUh
2300 Virginia Avenue, Fort Pierce FL 34982 lj`r
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �tsa� ► ckv r'%%,r
v. C.
wPROPOSED'IMPROVEMENT-L-OGA=TION.._-. -- - -=
Address: (00l7
Legal Description:-ZdJbI4Ti Ay1 5e f rLL 6z0(-/Z
1,o i 5 .3a+39
Property fax 0 it: 3402- /,Q 7 • ODio3 060 5 Lot No.
Site Plan Name: m2t\cie5 Block No.
Project Name:
Setbacks 'Front c25' Back: /5 ' Right Side: /d' Left Side: /O'
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION:, w _ -
AuditionaiworKtol3epertormed under tis permit - cneck a appy:
11HVAC U Gas Tank Gas Piping _Shutters ❑ Windows/Doors
[lE(eciric ElP'lumbing Dprin)C(ers 0denerator 0Aoof = Rooipitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ a YWr �O Utilities:Sewer Septic Building Height:
,„OWNER/LESSEE.•..-- ,. µ.:.-� _�. _ �_..;. __ __. ..�. _�,
-CONTRACTOR.. _ . w_ e..b._�_. _._._-�::�_ �..'� e-:-�=
Name fly aide
Name: 42
Address: %D)r7 A-fmN+-a D
Company:
City: Stater-
Zip Code: .34-4'78Z- Fax:
Phone No. %*7d-519 - o a s-0
Address:
City: State:_
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
It value m construction is $251313 or more, a RECORDED Notice of Commencement is required.
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12-
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 6uiiding permit applcaiions 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 th first inspection. If you intend to obtain financing, consult with lender or an attorney before
comme n work or recordingour Notice of Commencement.
i I 96'�'�L
NIPC
X.
Rev. 8/2/17
SUPPLEMENTALCONSTRUCf,IgN,LIENLA�WINFORMATION. t°
-
DESIGNER/ENGINEER:
Name:
_Not Applicable
MORTGAGE COMPANY:
Name:
_Not Applicable
Address:
Address:
-
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
,BONDING COMPANY:
Name•
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Sig lure f Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
S ATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5i' • 1- V I-A-9,
COUNTY OF
The forgoing instrument was acknowledge dbefore me
The forgoing instrument was ackn edged before me
this3.1 day of � ec . 20 � by
this _ day of 20_ by
Name of person making statement
Name of son making statement
Personalty Known' OR Produced Ident�cation'
Personally Kno OR Produced Identification
Type of Identification
Type of Ide cation
Produced
Produce
(Signature of Notary Pub is -State of
(Signature of Notary Public -State of Florida
' ONEt1s
t.IpMpR1E
Commission No. �.10�, d3�co�1�B�lceeGfi 023
Commission No. (Seal)
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=r �- EXPIRES: Ded� NwUnderwdlz�
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`oae Bonded�Notary
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