HomeMy WebLinkAboutBUILDING PERMIT APPLICATION'AII'APPLICABLE INFO MUST BE COMPLES ru FOR APPLICATION TO BE ACCEPTED
Date: I lrL SCANNED Permit Number: I (0D to l ] 4(
_ BY
� ;U. rt St. Lucie County
Planning and Development Services PERIAIT rING
Building and Code Regulation Division St. Lucie County, FL
2300Virginia Avenue, Fort Pierce FL 34982 ,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
0POSEDi1NPt01/EMENT
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Address:
I 3 $q 6
l h
h h- e 5Qri &och
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Legal Description: iN (`I �S
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a I I +h I Of-
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$ 4P. r-#
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P� W e and// Jo Al W �S
Ritr h K-lei
Property Tax ID #: U N — I✓ 01` 3-701 -1
Site Plan Name:
Project Name: DWft
Setbacks Front 33 Back: Right Side:
LeftSide:10
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _ Plumbing
'/� _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction:$ Utilities: _Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof
Building Height: �fo
y{,7�55
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Name I(I_S •i` I
Name 1�4K:
Address �3 FM-'=S ;lb '
(VQ✓ �IIV'e
Compariy .: (f
City'"'-' , I>2 j Stater
Zip Code: 3 H 9 S 'T Faax:I _
Phone No. SIQI of I �i09 �P
Address 3,5l '5 rLZe r
City: � w^ Statcer
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Zip Code: Fax: �6�0 o %
Phone No 37,0
E-Mail:CP 6 Y1)wt1 Mat• (01Y)
Fill in fee simple Title Holder on ext page (if different
from the Owner listed above)
E-Mail
State or County License Cjs}C/2$SPM
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
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.prohlbit 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,
fences, walls, s gns, screen rooms and accessory uses to another•non=residential use
accessory structures, swimming pools;
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
cnmmencing work or recording vour Notice of Commencement.
' i¢nafi%fi • wner,Lessee Agent
Signature of Contractor/License Holder
STATE OF FLORIDA c
COUNTY OF J-F' • LU u C
STATE OF FLORIDA c '
COUNTY OF
The forgoing instrument was acknowledged before me
The for ing instrument was acknowledged before me
this —day of 20_ by
this day of 1Ty/t, 20/1�, by
C I(\v'kVw Y' eti\rOWL\
L-0cz. 0tt1 avy-'S
(Name of person acknowledging )
(Name of person acknowledging)
LGt�/� ��G1/1LxV��sL�
�l/Zc�a
(Signature of Notary P lic- State of Florida)
(Signature Notary Public- State of Florid
OR Produced Identification
Personally Known _ZOR Produced Identification
Personally Known
Type of Identification
Produced _°1►wtiy'°••, Shelley L Harden
Type of Identification
Produced �f'• KARYN G DRAWDY
FIo30S0 zw �_ mLssion11FF1630SQ_
�" SEP 24, 2018
Commission No. :Til.... ,�i . �DED
=+ YCOMMISSION# FF11IM68
Commission No. EXDG3E BIjay t
: 7NRU
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Rev. //ZU14 - ' If