HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED R
Date: %� SCANNED Permit Number:V�
BY St.RECOVE®
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Building Permit Application MAY -9 2017
Planning and Development services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1579 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line i doo25I
cit000 s. • G! • V)hve unih iC05
PropertyTax ID #: 450Z- (oZ0' coi%' coo ` 7 Lot No.
Site Plan Name: FMnYPSS CnQCAQMI11L M Block No.
Project Name: >6em xn -PFSIcienrc
Setbacks Front Back: Right Side: Left Side:
Retr�ove + replace SlidinC� C31QSS dCOxS .
Windows/Doors
Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ Qi020.C� Utilities:Sewer ESeptic Building Height:
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CONT CTOR
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Name 1m(,)Y-dtPnnn I'
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Name: iaLZ[tiRro
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Address: y49,L-nKPS'hort Poin nr.
company:-T� IP QQ C
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City: 1�nINPII .'- .""� � =", 1. State,
Address:351(').SF �1X
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PhonezeUy Nou hL48-21r1,.,r36�F(a ''
Zip Code 3 �1�17 °' Fa;I '172-2,S(o-046,)
E-Mail: YCit 1Y 11 Z p V��(�(Yi5 Si
Phone No. '- 7Z`'7_i7�,"=
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Fill in fee simple Title Holder on next page (if different
E-Mail:
State or County License:
from the Owner listed above)
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUFPENlENTALCONSTitlCT10N�lEN=LAN/,INFORfVIAION
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ry:`-Nm
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY: —Not
Name:
Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not
Name:
Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 work or recording vour Notice of Commencement. rl\
as Agent for Owner
STATE OF FLORIDA I
COUNTY OF 1 r in IC,({ -H n
The forgoing instrument mtaj acknowledged fore me
thisi Lday of ap)'I1 20 by
STATE OF FLORIDA
COUNTYOF (My--M r)
The forgoing instrument was acknowledged before me
this M day ofAL�Yj 1 20 aby
Mr. A7 aIamonrj b�f0(j -bauid Laprade
(Name of person ackn wledging) (Name of person acknowledging)
/�e Di F a 2tA M apt-,-'
(Signafure of N ary Public -State —of Florida)
Personally Known OR Produce Identification
Type of Identification Produced IT
Commission No.
Revised
KELLY WIDMAN
Commission s FF 929255
My Comm. Expires Oct 20. 21
�00�2c.Pi�,r�2s
(Signature o otary Public- State of Florida j
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
8 FF 929255
'es Oct 20, 2019
Mn:.il N.— A....
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