HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,, ifU° l 0 Permit Number: I q-O a U qq3
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A8 RacEWED
BuildingPermit '� lication
PP FEB 2 0 2018
Planning and Development Services �nenr
Building and Code Regulation Division Stttj��te Countv
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578 Commercial Residential
PERMIT APPLICATION FOR: r2c= o�-
X S/f/w�Ge
,PROPOSED NPROVEMENT LOCATION:
Address: -3/%/ /jL/r/I/j /—�Viw
Legal Description: 41147' IZ V P 1 0 L Jr. 2 Z e e 7 (Oa i 7 fl (0
(D a N 0 LJ - — Z e, S- 3)
Property Tax ID#: ZN D,j 6'01 00 -�3 z O c?U—Lot No. 7
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�''DETAIL'ED'DESCRIPTION OF WORK: ` n
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_Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction: >/f/Z
Cost of Construction: $ I u
permit= cFec
_ Gas Piping
Sprinklers
all that apply:
_Shutters _Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor: IV
Utilities: _Sewer _Septic Building Height: �S rtJ FT
OWNER/LESSEE:
CONTRACTOR: b
NameL1.'�1 = - —
-—
_Name:: L%�JF%%a70 LT7�wv2.
AddPC
Company: �FJNr�i�i .T�iviLj� S, [ LG
citystate:�D-L
Zip Code: 7 ;J U I C> Fax:
Phone No.
Address: 39>iy ci yT!/�9TFD27 L.r�
City: �Olzc ci�� c c. c��j�G State: 1"(
Zip Code: 3l c/ 9S 3 Fax:
Phone No 777— Z L y 9// 0
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 60 f?) v% 6 9 t-7�-,S I r
State or County License e cZ_ / 3 7,0 77 7
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN
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LAW INFORMATION
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: s t;, : ,,,
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE,$IMPLE TITLE HOLDER:
Name: n
_ 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
commencine work or recordine vour Notice of Commencement.
of Owner/ Lessee/Contractor aVgqnt for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowl
this )t:) day of &.40
(Name of person
Personally Known
Type of Identifical
Produced
Commission No.
REVIEWS
0
STATE OF FLORIDA r
COUNTY OF S4 Lures-c T
The forgoing instrument was acknowledged befole me;
this 2L2 day of C-& L 20 y by r
mTl
i%)J n'l'-)-7� ' y
(Name of person acknowledging)
(Signature of Notary blic-State of Florida )
OR Produced Identification <_--", Personally Known OR Produced Identification L
Type of Identification
Produced _ dggEu.gHUMpHREy
AUDREY R HUj.V4M
REY L0.�M MY CUP.4d13510N Y iF 174772
h1YCOMMISSIOM Commission No. _'�.`EXPIRES•rlQatcf16'219
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