HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A
Date: CtSC�f�� Permit Number:
BY
St. LUriPr:nJJr?tV RECEIVEp
Building Permit Application SEP 11 2T9
Planning and Development Services
Building and Code Regulation Division
5T, 1,4c1e
2300 Virginia Avenue, Fort Pierce FL 34982 . County, I'ermltt
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: Rohe 5horl Lka GP4- S% Lucre 3Lf4&2
Legal Description: LKe5 c# PGA 1) r W /j pTY(26P_3907-2,Cq'
Property Tax ID #: ,333ti SOl olS4- 000 - (o Lot No.LKO
Site Plan Name: Block No.
Op
Project Name: J� ,_Vet+ Fio%zman
Setbacks Front Back: Right Side: Left Side:
SC)Up Foci _ 44ec,+ n 5 fe5�4m.
❑ Windows/Doors
11 Roof
Total Sq. Ft of Construction: ScFt. of First Floor:
00
Cost of Construction: $ .5{%(oi, ,✓� Utilities: _Sewer Eleptic Building Height:
w,QW,IUER%LESSEEt
f'CO. "•"NTR, ACTQR: . k t
R"
e `% 4,� . I
Name Ct L�Z r*i n
Name: Roo 2et--_ Zc i_Ar-Ar_K
Address: gU 1(0 S%b(� G%lin Comer•
Company: So(c! �rtplGu
�5 ifm3
City: T�_ S+ L k6e, State:
Zip Code: 39996o Fax:
Phone No. 91V Jd 990
Address: f0
City: r-or� it?CC2
Zip Code: a8�p
Phone No.-1-12.-LFfoy-2_i0v3
State: R -
Fax: 112 4Wo-7q3�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:Sn1SOIa -p-og a
u (`�
State or County License: GVC
OStacn3-I
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
J
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 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
commencingwork or recordingour Notice of Commencement.
e
Rev. 8/2/17
'SUPPL�MENTA CONSTRU�CTIO'N
LIEN LAW INFORMA°TION,
y.ytt
� � ���"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:
� l�itc.C.E'cl�/_
x ��-dI>-eJl, /n,eX.('i.�✓�—
Signature of Contractor nse Holder
Signature of Owner/ Le Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLOR DA
COUNTY OF
COUNTY OF S� I,uGIZ
The forgoing instrument was acknowledged before me
The for Ding instrument ryas acknowledged before me
� �Pp�
this _day of 20_ by
this day of i, 2oL by
�bP�k Z�r��la.G1�
Name of person making statement
Name of perso making statement
Personally Known OR Produced Identification
Personally Known � OR
Type of Identification
Type of Identification A;:;* Notary Public State of Fiori
Produced
Produced Marie Sarah Blystone
My Commission GG 36129
%7,'jif Expires O6/242023
(Signature of Notary Public- State of Florida)
(Si ature of Notary Public- 9