HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPgWffiy8 BE ACCEPTED
Date: BY permit Number: 1O� ii3IS�
St. Lucie County
Planning and DevelopmencServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
AUG 16 P017
St. Luce C�of/,yG
Unh..
Commercial X Residential Fr
( PERMIT APPLICATION FOR: �( :PP_V0aP Poi- Roc)(
Address:
Legal Description: la 3-7 Ll1
Property Tax 1D i#: / - I - - Lot No.
Site Plan Name: lel Block No.
Project Name: Q % %o qpg
Setbacks Front Back: Right Side: Left Side:
_Mechanical , Gas Tank Gas Piping —Shutters _ Windows/Doors
_ Electric — Plumbing Sprinklers _ Generator Roof
Total Sq. Ft of Construction: (I)
Lost of Construction;$ /'S/DICi.p0
Sq. Ft. of First Floor;
Utilities; _Sewer _Septic Building Height:
OWNER/LESSEE , , ' a .u,
'CONT_RACTOR:..
Name EFTV k-k
Name: L
Address: 1Jr-
Company:_
City: Stater
zip c e:A�R6-7 Fax:
PhoneNo.'I-7a -Q3-7 51161
Address-3 I(_ -'S ')toYtf- 5f
city: ` C ' State: F
z;peode: (�%a% Fax:-77,'?,29 i:M3
Phone No -TTa cP83 2&��q
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
Lode roid vm cpw_
State or County
If value of construction is 2500 or more, a RECORDED Notice of Commencement Is required.
Name — -- .-.- -----
Address•
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _Not Applicable
Name:
Address:
City:
Zip:_Phone•
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application, is hereby made to obtain 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. Lucle. County makes no representation that Isgranting apermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules; bylaws or atu�covenants that may restrict or prohibit such
stricture. 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.htli concurrency review: room additions,
accessory structures, swimming poals< 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, consuttwith lender or an attorney before
signature of Owner/ Lessee/Contractor as Agent for Ovmer Signalture of Contractor/License Holder
STATE OF FLOI STATE OF FLOR�Dpp �
COUNTY OF ///1/LI, n COUNTY.OF NIU ts{9 Yl
The fa oing instru ent mas a nowledged before me
this ir day of 20a by
IP rlry (Q �iGi U Yf . Aar lAag �
(Name of ersonac xiedging T
.
(SignattiteofNotS?OR
StatgoitFlorida}
Persona..11ll) Known Produced Identification
Type of Identification
Produced
Commission No. I I (p (Q (seal)
The for oInginstru ent was acknowledged before me
this dwl of _AU V 20� 6y
�oi�e �
(Name of per on acknowledging)
. Slgnatu a of N-0ta`rVPuPIfc=SirW o orida j
Personally Known -.VI—OR. Produced identification
Type of identification
Produced
Commission No.3 (Seal)
SUPERVISOR
I REXIE4tr I V E Myd MREVIEW