HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONt
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEu
Date:
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:
Address:
Legal Description:
SCANNED Permit Number: D�---1��'
BY • R C11] �I�E
St l 1 irio rounty
APR 1.5 2017
Building Permit Applicatiogii. works
St. Lucie County, FL
Commercial Residential
Property Tax ID #: �S 9 Z t Z S E &' %: ) 0 00 Qot No.
Site Plan Name: VCZ4N ps Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/DS, Ia "i, 9-c*' �o-
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq., Ft'of Construction: Sq. Ft. of First Floor:
Cost. of'Construction: $ Utilities: Sewer Septic Building Height:
OWNER%LE-SSEE:
CONTRACTOR:
Name.-.. „r
Name:. L. o l
S 096+}rJ
r�
:Address:
Company: ,Iota (�2
c u
City
Zip Code: 3 Z9 [e C,) Fax: '7 -<-ijq
Phone No. '-Y)"L S i
Address: O!1OCT.,
-
City: 1/E4ra I �
Zip Code: ��Q_(o O Fax:
No - 5-3la'-Ogi(n
State,
L�l-
E-Mail:�,,�\1��+T✓�")I.Con. -.Phone
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
I?�2
E-Mail cl �lu_ Cif oncD trLi,400.1"
n
State or County License e(7 C 0(-1
O1 2�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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-eesidential 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
rnmmencinAvork or recording vour Notice of Commencement.
Owner/ Lessee/Contractor as Agent for Owner
Sign tu;F-F—LOJIDA
Signature of Contractor/License Holder
STATE �J
STATEOF Ft9RFBA` / rI,/F
A l() d�-t l
COUNTYOF_��AAI illtY�Uv�+
The f go'. g instrur�enthwas acknowledged before me
May
The forPoing instru nt wa acknowled ed before me
1�CVIday 20U by
this of �1 .20� by
this of
��
< <w.
(Name of person acknowl ing) _
(Name of person acknowledging)
(Si ature of Notary Publi - tate of Florida)
�naturff otaPublic-State �e oof Flefida) NFER I C
%
Personally Known
Personally Known OR Produced IdetItIl9i'
Type of Identification ?;o;'" "a°:; JOLENE K. SOUTHWICK
Type of Identification
Produced—' MY COMMISSION #FF079740
Produced
AUB��(JJ
o?. IRES December 29. 2017
�I� ���0012n
Commission No. I (3P, '•. r
Commission No. 7 r F(SeMoraryservice.com
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