HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE -INFO MUST BE COMPLETED 1FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: lira �k!313 13
SGANNEL,
RECEI -D KC 012016 BY
-St. Lucie Coijntl
Building,Permit Application
Planning and Development Services
Building and Code Rigulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 tial
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Y Residen
PERMIT APPLICATION FOR:,�-,
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Address:-10,Goo .9�ovtt�
Description:
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Site Plan Name: Block No.
Project Name"
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Total Sq. Ft of Construction: Q 0 Sq. Ft. of First Floor:
'Cost of Construction: $ Utilities: _Sewer Septic Building Height:
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Fill in fee simple Title Holder on next page (if different
State or County License
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from the Owner listed above)
struction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEE Not Applicable MOR GAGE COMPANY: _)�,Not Applicable
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Name: q>A C�z
Address: - ;P9_ J&j13260 R& S+ Address:
City: Ve LL'61 State: City: State:
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Zip: ?41J8'J Phone 9_�? r7 a - nv-s �R_l Zip: Phone:
FEE SIMPLE TITLE HOLDER: _�I, Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING
Name: —
Address:
City:
Zip:
Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby mad ' e to obtain a permit to clothe work and installation as indicated.
I certify that no workor 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 work or recording your Notice of Commencement.
Sigh5iure of own&r/ Leisee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this I] day of NOV-9_110d'7— 20_L� by
this-adayof 20_Li�by
A-Ll'�N MA-7L c-u 5
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(Name of person acknowledging)
(Name of person acknowledging)
gnature of Notary Public- State of Florida
(Signature o , otary Public- State of F10'ricla I
(Pe.rs'onally Known OR Produced Identification
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Type of Ide2nn
Personally nown OR Produced4clentification
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