HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0
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ALL APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1'-4- e SCANNED Permit Number:
9
BY
St. Lucie County
Building Permit Applicatio :RECEIVED—
BuildingPlanning and Development Services and Code Regulation Division J0 4 2018
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial s14��iMlnty, pev
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I:;,: -
Address: -ru V UJ r L!I-hwn�j J
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Legal Description: _ 22 36 40 N 120 FT OF S 400 FT LYG E OF US I (1.13 AC) (OR 703-0051:
956-5: 2873-2810: 3590-1345)
Property Tax ID #J q14 y
Site Plan Name: /^+
Project Name: hiC17l
Setbacks Front Back:
0
Right Side: Left Side:
ace S a— . top ►
15Or 0� S
Lot No.
Block No.
Muu; uU[;d I wu1n w ue e11U1111CU unuer um perm¢—a;ecxdn
❑HVAC Gas Tank ❑Gas Piping
dpply:
❑Windows/Doors
_Shutters
Electric
0 Plumbing []Sprinklers
❑ Generator
❑ Roof ❑ Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
9O
Cost of Construction:$CR�Kp,
Utilities:cnSewer❑Septic
Building Height: S/
OWNER/LESSEE:
CONTRACTOR:
Namel?(Pr( He'l ,?dip9.' US
I.0 Wrwe TCe.
Address:lqua_ D/IJe,
Company:
City:%S6--N eve-&(J-N Stater__.
Zip Codej Fax:
Phone No. 440-33y.923y
Address
City: State:_.
Zip Cod _ —t Fax:,
Phone No. a'003' zo%3
-E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:yerl�,1��1IpI .Smite , CONY-.
_
State or County License: 7_L0'Zlo 2-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. CJ-r U
(3) 'Su'(V(_q
C4 C(El, ��
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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
commencingwork or rec0rdin our Notice of Commencement.
Rev.8/2/17
FLORIDA
' ture of Owner/ L e/Contractor as Agent for Owner
Sigi re of Contractor/Lic� Holder
STATE OF FLORIDA
COUNTY �A}f`�/`f
STATE OF FLORIDA
OF
COUNTY OF rti,/�(�-I—i/J
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 201� by
this _ day of 20f�by
InT
t'1 l`Q/l
Name of person aking statement
Name of perso aking statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No aryublic- Stale of Florida) CourtneySam
N(Signature of Not c-State f Florey Samsel
at�y NOTARY PUS
Commission No.�go49�'30 or y
-IC ��� NOTARY PUBLIC
mission No. O � Sij�)OF
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