HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t 01191/ / 7
Permit Number:
max M _= SGANNED
Building Permit Application BY
county
Planning and Development Services St Lucie
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial t/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 76/ C P Q whC_ v I s; 7s 6Lk_�6
Legal Description: Srt /s-r1- A-CIJ-
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front V / Back:
D/ 5' D- O 01
Right Side:
DETAILED DESCRIPTION OF WORK:
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Left Side: 4/0 '
3,(J 2oc�.0
Lot No.
Block No.
I CONSTRUCTION INFORMATION: Ill
gHVAC Li Gas Tank
Electric E-1 Plumbing
Piping LJShutters ❑Windows/Doors
nklers E]Generator 1:1 Roof
Total Sq. Ft of Construction: uSf Sq. Ft. of First Floor:
Cost of Construction: $ S-, 2 �(7 Utilities. Sewer Septic
Building Height:
Roof pitch
OWNER/LESSEE:
CONTRACTOR:
Name R)G1-1FAQ ✓9 /_1l�_Y 174.4_5>-
Name:
Company: Si G W C� n i zcr��✓\ __
Address: 21 b'Z Al"_ r A-Q-/ ham Ln
City: SQA �Ri% 6aLC-/^ State: rl-
Zip Code: 3 `/ 5 5 7 Fax: _
Phone No._ 21 L4 - 15-6 c/ 7
E-Mail:
Address: (o 7 Z ci 5 L L a n v\w �A- TL-A
City: V S L State: P�
Zip Code: 3 i `I 5 'L Fax: 3 3 7 O £sa 6
Phone No. 33 S- 2yiq /
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: S 1 G rV C ,9 ✓1 rn L 0� P 5 L
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State or County License:
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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: Pa�� :�r'_
Address:I q r" L-c 41 VAI_�n- LC s
City: IP 5L State: f%L
Zip: 3 � 9 19'`1 Phone 7fs5 — 15 99 `6
FEE SIMPLE TITLE HOLDER: _ Not Applicable
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
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-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
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 8,� 1....1., e
The for oing instrument was acknowledged before me
this If day of OcT bCt— 2011 by
Name of persci making statement
Personally Known OR Produced Identification
Type of Identification
Produced
STATE OF FLORIDq.+- LAG e
COUNTY OF cc��
The forgoing instrument was acknowledged before me
this 19 day of 20—LZ by
Name of persgn making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida) (Sign ure of Notary Public- State of Florida )
Commission
REVIEWS I FRONT
COUNTER
RECEIVED
Rev. 8/2/17
REVIEW
Stew of FWW A
PLANS I VEGETATION
REVIEW REVIEW
Notory Public State of Fbd"
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My Commissbn GG 100E10
REVIEW I REVIEW