HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E INF MUST BE COMPL--- 2J FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED
BY
St. Lucie Countv
Building Permit Application
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 Residential
PERMIT APPLICATION FOR:
AAf-rM I A I kii% 1P& A Mkt1 I A t1l k I. ;fa ti,
Address: (n Q
Legal Description:
PropertyTaxID #: No� - z"41 -00(3� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
D ETAILED D ES " C -RIPTION OF WORK:
N
161
—Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
— Electric Plumbin _Sprinklers — Generator Roof
Total-Sq. Ft of -Construction: - - - -1 - --Sq. Ft. of First Floor:
OWNER/LESSEE:,
CONTRACTOR:
Name
Namq. Ov
Address:
Company:
City:- tent state:
Zip Code: Fax:
Phone No.
Address: &;1"L(t)
City: UU Viert-k- State:-F-(
Zip Code: Fax:
Phone N&,.
E-Mail:
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
State or County License:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL'.' ONSTR N LIEN LAW INFORMATI,OIU
'40
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 rules, bylaws or that
and covenants 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 Coropencement may result in your paying twice for
improvements to your property. A Notice of Commenceme must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing onsult with lender or an attorney before
commencing work or recording our Notice of Commence
Signatt'rrfof Owner/ Agent/ Lessee
Sign re of ontractor/License Holder
STATE OF FLORIDA
STA OF FLORIDA
COUNTY OF L�, r: o ,
CO OF -�A -1,., w, ;
The forgoing instrument was acknowledged before me
The forgoing instr ent was acknowledged before me
this day of 20 l� by
this day of (�, 20 Eby
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- S e of Florida )
(Signature of Notary Publi State of Florida)
Personally Known &P-rodueed-lde i
Personally Known R Produced Identification
Type of Identification P dµg♦#d'i 's LASH
Type of Identification Pro° ucg
f,i NFv1 0, 2018
Commission No. - • ; My cam lI11Expires Dec 20, 2018
# FF 177249
y�..
,� 4iK ANNA INUMAM
. .:: Notary P�ub+`c -State of Florida
Commission No. =N�� • My Catr�Si`4ipires
o= CSsion
Bonded through National Notary Assn.
Dec 20, 2018
°•' Commission # FF 177249
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