HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C
Date: '1119- S/ %C%
-
FOR APPLICATION TO BE ACCEPTED - '—�
SCANNED Permit Number'
By ISt. Lucie County
Building Permit
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 _
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION. FOR: n, , _ __ .- . _ r
Address: -:).7J
Legal Description:
F - ?n i
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front.
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Back: / / / I W w Right Side:
u
Applic tion OCT 3 2019
Permitting Department
St. Lucie County, FL
Residential
A00monal WorK TO Oe perrormeu UnUef UUs PeI n IL— UICLM au u40L Upply.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_Electric Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: QSO Sq. Ft. of First Floor.
Cost of Construction: $.' Q 7�. Utilities: =,Sewer _Septic
City: L State: lf4
Zip Code: Fax:
Phone No. .S-2$ • 3 �g
E-Mail:
Fill in fee simple Title Holder on next page (if different
`ram the Owner listed above)
City:
Zip Col
Phone
State or County
Lot No.
Block No.
Windows/Doors
—Roof
1.
Building Height:
U1v
&) ao /
Stab
Fax: 46 S "-
of construction is 2500 or more, a RECORDED Notice of Commencementis required.
DESIGNE
Name:
/ENGINEER:
Not Applicable
-S
MORTGAGE COMPANY: _Not Applicable
Name:
Address:
Address:
City:
Zip:
L
Phone
_
/,rJoL
State: /
— / c�
City: State:
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
_
BONDING COMPANY: —NotApplicable
Name:
Address:
City:
Address:
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 issuan4e.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 yourdeed 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 Codrity 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'pajring twice for
improvements to your roperty. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspe ion. if you intend to obtain financing, consult with lender or an attorney before
rnmmencinswor cording vour Notice of Commencement. • ,
J"�
"44�- - ___1
Signature of Owner/ Agent/ Lessee/Contractor
Signaturee%T Contractor/License Holder
STATE OF FLORIDA n
STATE OF FLORIDp•` - / -
COUNTY OF <1 �/L�,[ 2J
COUNTY OF_ c (V GL/ e1 L1J
The f r ing instru nt w s acknowledged before me
The fgrgging instrume. wasacknowledged before_ me,
L_S�day
this` day of 20/7 by
this of 20f5by
/
Name of erson acknowle 'ng)
Z
(Name of person acknowledging)
la'r I xx
(Sig ature of Nota lic- ate of Florida)
ignature of No .ublic-State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Ot�YP°B SHERRI FEHLMAN
�'/^1 e:•••..Vo
Type of Identification
ProducedCommissionRGG187160
Produced ,°" Pie- SHERRIFEHLYM
Expires March 14, 2022
`eP
• : Commission # GG 187160
Commission No.Commission.No.
(6onir,'m 14,2022
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Rev.7/2014