HomeMy WebLinkAboutBUILDING PERMIT APPLICATION111-
All APPLICABLE INFO MUST BE COMPLE` ;FOR APPLICATION TO BE ACCEPTED
Date: 51 Iq 1 5 Permit Number: �� St d ��o
RECEIVED MAY 19'20�i
SCANNED
Building Permit Application By
Planning and Development Services tit LUcie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITAPPLICATION FOR: Sid^
Address: too Iv' us) T Trpir 'tr:
Legal Description:
I- 6 S lio l pj37 3 9' k-qq kj �y f 00 �- 9-1-
1l 3 !p —Uss
rJCIASS �NogK 1TZ,-3RI or L6,LF9040-37rS--zZ`R'S
Property Tax ID #: 2t♦ D3- go-L -D0377 r 000- IgLot No. 37 - 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
'!0 X zo
Additional work to a pe orme under tis permit -check all that app y:
^`
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric Plumping Sprinklers _ Generator _ Roof
— _ _
Total Sq. Ft of Constructiom 3D _ Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
148,11
Name Girlwti k
Name:
Address:
S- N V;
Company:
City: I(xup� State:
Address: a 00 t/ 6"r a ej !2
City: J�1 10i Y ec a State
Zip Code: '34°I 5 HV Fax:
Phone No.
Zip Code: -3 y qg, 1 Fax:
E-Mail:
Phone No 712 L-173 " .4 If 9-
Fill in fee simple Title Holder on next page (if different :
E-Mail
State or County License 2ti 2.
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 bylaws
rules, 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
commencing work or recording our Notice of Commencement.
-Signature of Owner/ Lessee/Agent
�Siignature of Contractor License Holder
STATE OF FLORIDA,
Lt4
STATE OF FLORIDA
COUNTY OF_ c;e
COUNTYOF 47'
The forgoing instrum nt was acknowledged fore me
this l 7 day of � O� 20�by_
The for oing instrument was acknowledged before me
this day of by
__ _
A11!W
..ctiarc!
/20_
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Pu lic- State of Florida)
(Signature of Notary Public, )
Personally Known L OR Produced Identification
Personally Known —OR Produced Identification
Type of Identification
Type of Identificat.je
Produced MISTY BOBILIN
w•n, MISTY BOBILIN
al)EXPIRES: MAR 13, 2017locimuced
�����" MYCOMMISSION#EE883
Commission No.
IY COMMISSION;#EE883700
mission No.aR:-' 'bS; MAR 13,2017
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PLANS
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REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVI W
REVIEW
REVIEW
REVIEW.
REVIEW
DATE
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RECEIVED
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DATE
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