HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr{•
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: (Q�
BY
S . Lucie County
AUG 3 ® 2017
Building Permit Application
Planning and Development Services PERMITTING/ St. Lucie County, FL
Building and Code Regulation Division f///
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-15 8 Commercial Residential
PERMIT APPLICATION FOR: To Se ect from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCH ON:
Address: 4 W CL C_ IRN c� ck_. (�
Legal Description: or, a.r.E- r%S
Property Tax ID #: Lot No.
Site Plan Name: ': 1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED.DESCRIATION OF WORK Y /.
5 Cot Lk t &"t3 S l�o
I CONSTRUCTION.INFORMATION:,. I
[eIHVAC Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction: _
Cost of Constructio .
Piping I (Shutters
nklers 11 Generator
_ S Ft, of First Floor: _
Litilities:ll Sewer E] Septic
Windows/Doors
Roof = Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
a el.CY2�'K$rte C 'r t
Ad ress: 0 L
City:R J7tIle) c_g ::t
Zip Code: qrF-ax:
Phone.No.,B�_ `iSS4. t) 5J .
E-Mail:
Name:
Company:
State:
Address: AA11'.�& S
City: c,e. State:
Zip Code: 3y q Fax: 7� �- Y Pa 1tS
Phone No. Z-7a.— c3 8 ti - a59 B
Fill In fee simple Title Holder on next page
from the Owner listed above)
if different
E-Mail: O(v'l
State or County License:
IT value or Construction is SZsuo or more, a REcPRDED Notice of Commencement is required.
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N.1',rL � a;�f�1g�^..>
DESIGNER/ENGINEER: —Not,
Name:
pplicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: SI
ate:
Address:
City: State:
Zip: Phone:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Not
Name:
pplicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: App
1 certify that no work or installation has comn
St. Lucie Counmakes no representation that
which is in conflty ict with any applicable Home c
structure. Please consult with your Home Owr
In consideration of the granting of this request
In accordance with the approved plans, the Flc
The following building permit applications are
accessory structures, swimming pools, fences,
WARNING TO OWNER: Your failure to I
improvements to your property. A Not
before the first-irtsoection. ltv u.inten
ion Is hereby made to obtain a permit to do the work and installation as indicated.
ed prior to the issuance of a permit.
ranting a permit will authorize the permit holder to build the subject structure
ers Association rules, bylaws or and covenants that may restrict or prohibit such
Association and review your deed for any restrictions which may apply.
termit, I do hereby agree that I will, in all respects, perform the work
i Building Codes and St. Lucie County Amendments.
mpt from undergoing a full concurrency review: room additions,
Is, signs, screen rooms and accessory uses to another non-residential use
ird a Notice of Commencement may result In your paying twice for
of Commencement must be recorded and posted on the jobsite
> obtain financing, consult with lendeyof ap-attorney before
It
•gnatur o wn Vie/ ractor s get for Owner Signature of Contractor/Licet
I
STATE OF FLORIDA ! STATE OF FLORIDA
COUNTY OF VB r• rd COUNTY OF
The for ing instrument Was acknowledged be ore me The forgoing instrument was
this, dayof ^ 13,PIP —20_L7 b this Z-tday of y
uledged before me
?�20 0 by
c7L—_
Name of persoVn gtaking statement Name of perso5;naking statement
Personally Known OR Produced Identification _ Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
i
I
(Signature of Notary Public- - nature of Nota r 6>1
DYGEIGER
o'w4w Prad State MFbritla '�• 't? MycoytSlISBIONiFF956276
Commission No. x .ry�ja X rady C mission No. 'S o EXPI141Y� �AjI 91 2020
11 3p M1o�P� My mimi sion G0 008249 %.,'+,�-A� „ BondedTMt Nota(y Pubfic undamrilen
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Rev.8/2/17