HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMF'_c:`-D FOR APPLICATION TO BE ACCEPTED
Date:%��� �� SCANNED Permit Number: O4• 1.
BY
;t Lucie County
Building Permit Application RECEIVED
Planning and Development Services AK; 9 A 2019
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 re st in
�ePartment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 01 ounly
PERMIT APPLICATION FOR:
Address: 60/ 7 /SexeAunan ( V; � rd, A-, f/ Sn1YYYA
Legal Description: jsndzIan ,,—e7r V � f 9 10
w
Property Tax ID#: 76,2 - 6 0 3 Lot No. 768E 6 1
Site Plan Name: Block No. A
Project Name:
v Setbacks Front / a , Back:� Right Side: ✓ q / Left Side:
Haumonai worK to De perrormeu unuer mis perms — cneCK aiimat appiy: /
_Mechanical _Gas Tank _Gas Piping _Shutters ✓Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof M Pitch
Total Sq. Ft of Construction: 16 � C) Sq. Ft. of First Floor: 6 00
Cost of Construction: $ �� 000 Utilities: _ Sewer _ Septic Building Height:
OWNER/LEcr-1:1
CONTRACTOR:
Name -eo
i /,'Pn
Name:
Address: (0/7 /3 r. nan
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-,. P axlvtU^ri-,, .: ;.;ik
Com an�r ni
City:S
F, 0,
State:
J VVGI +r
Zip Code: /. Fax:
State:_
Phone No. 77.2, .SA 6 8,17
1-/
Zip Code: Fax:
Phone No
E-Mail: W08zUTA&0& P 6r11C'09A 4 i+ e,
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL -@Wffim, I • ,LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
1 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.
1 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.
Inconsideration 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,
accessdry structures, swimming pools, fences, walls, signs, screen room s'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 recordin our Notice of Commencement.
yo �
Signa re of Owner/.Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder_
STATE OF FLORIDA ., —
STATE OFTLORIDA
COUNTY OF `
COUNTY OF
The forgoing instr merit was acknowledg before me
The forgoing instrument was acknowledged before me
this _A day of ?A �II 20� by
this _ day of , 20_ by
Name of person Ong QLatement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
( g ture of Notary PUbIlD State of Florid
(Signature of Notary Public- State of Florida )
Commission No. r'tin! :"'•,
mmission No. \+ (Seal)
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REVIEW
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DATE
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DATE
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