HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE'. __ FOR APPLICATION TO BE ACCEPTED L - /� ' f
Date: J'30- = Permit Number: 'So0 t-j
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
POPOSEDINPROEMA-Np�T- QOCAcTELII
Address: SDc
Legal Descriptio d -
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�.TLRA ON Ay ciTv Si
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
SCANNED
BY
St. Luce County
Building Permit Application
Commercial CG Residential
Right Side: Left Side:
Q
Lot No. J!"
Block No. (3
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _{-Sprinklers
Total Sq. Ft of Construction: 4 CO 7K
_ Generator _ Roof
Sq. Ft. of First Floor:
Cost of Construction: $ 0C!0 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name— 46 E- tie P3A W) ct Z Z.
Name:
Address: A?� 1H I J Col A%1 , Q. J.
Company:
City: State: FL
Zip Code: 7j S/i$ a Fax: o
Phone No. 5 3- 3 TO
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different •
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
UI RRO MENTAL CONST TION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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.
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
commencing woAk,6r%recording your Notice of Commencement._-A-/\_��-%
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Signature o r Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORID 4C.CP
COUNTY OFF ,t
COUNTY OF
The f oin g instr ent as acknowledged before me
The forgging instr ent as acknowledged be�ffore me
this day of �, 20Jby
this day of 20—B by
�y"IWVJ
�+P/1
(Name of person acknowledging)
(Name of person acknowledging) T/�
^
!./ eq_A A M `
`
� c 1 Liir1
(Signature of Notary Public - State Florida)
(Signature of Notary Public -State f Florida )
Personally Know9--__
Personally Known Pd d +ron'r i
Type of Id t''fi aDAWN MILONE
Type of Id of atio ��d:% DAWN MILONE Fj
Produced t�ota Public- Stale oYFlorida
ry
; °`� ` '' Notar Public - state of Florida
Produced:: .^? Y
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;: , ' �, •_ My Comm: Expires Mar 22, 2017Commission
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No.Corhmlii� 88I�EE 677571
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Commission No. �;'� �" CoAlml��44 I� EE r
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