HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COM "Lt ii ED FOR
Date:
TION TO BE ACCEPTED .-1 2
Permit Number:
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A8
03NNH0R
RECEIVED
-�� Se i�g Permit Application 1.
WV $ M5
Planning and Development Services
Building and Code Regulation Division BY PERMITTING
} St. Lucie County, 2300 Virginia Avenue, Fort Pierce FL 34981 �dt, LuC�e CoUnig� N, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
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Property Tax ID#:.7V-2,1-,S'OC9 'd/92-dO01y Lot No.
Site Plan Name:
Project Name: l' Rn�CG✓
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ da 11
_ Gas Piping
_Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor:
i
Block No.
Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
OWNER/LE-SSEE:
CONTRACTOR:
Name A 4H G✓
Name: ie r
Address: 11 &Iec/ id1-a t(e urn / /01
Company: a O w
City: 4—J c JZ Gt.eState:_
Fax:
Zip Code: 3 q I," 7-fi
a2 Phone No. f% VJ 7 3
Address: oil
City: .rri�t ' _ State: /l
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Zip Code: 3 Y% yG Fax:7%i-4/d1
Phone No. .2— 6
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
E-Mail: ,1_0 P✓?, -ek,.- ofG e �a ��. �✓�
State or County License: S�l3//S/moo
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEE
Name:
Address: A i
City: ' State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:__
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 1 /1
City: I State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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'l 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 vour Notice of Commencement.
SiErhatufe of Owner ent/ Lessee . _
gnat rere oi�r/License Holder
STATE OF FLORIDA
STATE OF FLORID .
COUNTY OF
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledgeA before me
this day of �'- 20 K by
this 1b day of iJo d 20_� by
SkAb
Sku1
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(Name of person acknowledging)
(Name of person acknowledging j
(Si tur a of Notary Public- S e of Florida)
(Si at re of Notary Public- ate of Florida )
Personally Known OR Produced IdentiFt I�
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identificatio roduraa
Commission No. LAr A'rA INGRAM
Notary In Slate of Florida
,o•t¢vr� LASHAHNAING. M,
Commission No. =�� y •`'. t' Notary PuTSL-A)ate'ol Florida
' - • My Comm. Expires Dec 20, 2018
- . •_ y Comm. xpires Dec 20. 2018
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