HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: ), ) V-• J 2 SCANNED Permit Number: 7� I ' 0 ) cP
. BY
='^d St. Lucie County RECEOVE®
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Building Permit Application NOV 14 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address;
Legal D-Ifknf-ld-A• era"f : t -&IF& �0
PropertyTaxlD#: i4-502-504--0052-_0Q0_9 Lot No.
Site Plan Name: 14) and I enp h C14 h Block No.
Project Name: Ar)9e11 ?,esl denCP
Setbacks Front Back: Right Side: Left Side:
Rernpve and reface
e errormea
GasTank
unaerm,sperma-cr
❑Gas Piping
0 Plumbing
Sprinklers
O> suding Glass door,
Shutters Windows/Doors
Generator D Roof = Roof pitch
Total Sq. Ft of Construction; S Ft. of First Floor:
Cost of Construction: $ tp.qW Utilities:0 Sewer Llo�J Septic 4 Building Height:
UMER SSE: ;�
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Name Rnherk -V Son t-0 AP.N
Name: 'hQWr'i IIIPYT�C1e
Address: R�YM S P()Yl D'Y I Inn y03
Company:-11ne (11WS PknkmS
(311Q(,S
City: jf-nj`PY1 State: ft
Zip Code:-1 Fax: M! 33=_
PhoneNo. Z 7
Address: '36-70 SE-bWC 4\yjY
city: .r4
Zip Code: 34*11 Fax: 77a-a2810-O4&1
Phone No. 7lZ'ZEi(o-O�F59
State:Ft-
E-Mail: Yt
Fill in fee simple Ale Holder on next page (if different
from the Owner listed above)
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State or County License: 1 d 3 fo::�
If value of construction Is S2500 or more, a RECORDED Notice of Commencement is required.
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MORTGAGE COMPANY:
_ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: _ _ _ Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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-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
as Agent
STATE OF FLORIDA STATE OF FLORIDA Y�� n
COUNTY OF iY�n �kl Yl COUNTY OF VG In
The forgoing instrument was acknowledged before me
this;Qday of OC±OiJPX , 20-U by
uS nX 1 -r d
Name of perso making statement
Personally Known OR Produced Identification T
Type of Identification
Produced
The forgoing instrument was acknowledged before me
this M day of Y 201 by
p
I d—
Name of perso taking statemept
Personally Known OR Produced Identification
Type of Identification
Produced
I t iM�
(Signature of Notan ublic- State of Florida i (Signature of Not 6
Public-State of Florida I
Commission No.
Notary Public - State of Florida
Commission # FF 929255
REVIEWS
KELLY WIDMAN
Public - State of Florida
ROVE