HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE'eo'rOR APPLICATION.TO BE ACCEPTED
Date: a.vs Permit Number: \gvG)-0lro
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Appl
Commercial
AN 2 8 2019
ST. Lucie 6
Residential
PERMIT APPLICATION FOR: q C�V � t-4,�JN dSC,4AI,,-
Address: & �X�
Legal Description:
PropertyTaxlD#: Q.\S4 -1661-60\\ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2G Utilities: _ Sewer _Septic Building Height:
OWNER/ ESSEE:
CONTRACTOR:
Name
Name: kr11LT2;-.n g
� L
Addre s: o,
City:' State:(-
Zip Code: Fax:
Phone No.
Company:`KUc
Address: -AO:C c.ya
City: PpState: k -
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 2 i1A w c
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTrAL G0_N 11ON LIEN LAW INFORMATION:
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 now -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 our Notice of Commencement.
Signature of Ow r/ L'essee .Con or as Agent for Owner
Signatu�of Co tract U ens older
STATE OF, LORIDA
COUNTY OF l- V �Q
STATE OF FL ID
�St
S�0 •
COUNTY OF S_r. CY
The for oing instrument was acknowled$$ d before me
thisa� day �q+�
The fo going instrument was acknowledged before me
Zscks
of 201 by
this day of 20� by
e b f O v, 'k 7
Ei \ c �> i ,, mil'
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of IdentifV
Produced 1�_�
Produced >b l
(Signature of Notary Pu c- State of Florida)
(Signature of NotaryPublic- State of Florida )
EGNF3is
Commission No. Cif aa1 DEw10%OGG 6'ap
Commission No. .. �� DEANAIAM )6 ,
.•,M""49. �(GOMM\S m 162� to,s
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Rev. 612/17