HomeMy WebLinkAboutBUILDING PERMIT APPLICATION\.
All APPLICABLE INFO MUST BE Ct I PLETED FOR APPLICATION TO BE ACCEP D n
Date: �� 1 �(� SCANNED Permit Number:
BY
?. St. Lucie County
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Planning and Development Buildin Permit Application MAR
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opment Services e nn;
Building and Code Regulation Division St [rr0 a�pa'`t,L.);y
2300 Virginia Avenue, Fort Pierce FL 34982 _" �Y
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: �%L�CIiSia��C/�E'l P i CJPS
Address: hU;
Legal Description:
Property Tax ID#: 5.,VclUr- 06
Site Plan Name: lzeCo 10q—
Project Name: SIdA)
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
,COVSTRUCTI,ONINFORM
ATION,.', :.."
Aa3rtiona wor to a per ormea unn er tnis permit- cneCK all tat apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ����• 0*90� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: n _, ;
CONTRACTOR: a
Name
Name:
�1
Address: SUS A I -J
a
Cbmpany,;,.
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City: Pz-f P;�RC,P State:(•
Zip Code: Fax:
Phone No. —77a - a i fin- Rr 3
�F�y�y
Ad&+dressw:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: DT i tx 9? 1 v UP •Co r'1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:;
City:
Zip: Phone:
UKIVIAI lvkYs� I
� '0. tl d. SAlu ♦� e
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not App
Address:
City:
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 yytintend to obtain financing, consult with lender or an attorney before
of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF -<4 ICOUNTYOF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of f WNnc L., 20 6 by this _ day of 20_ by
'LAYlaily 0n=CLU Q
(Name of person acknowledging) (Name of person acknowledging)
La,Q.ayht �
(Signature of Notary Public- State of Florida )
(Signature of Notary Public -State of Florida )
Personally Known . OR Produced Identifle
Personally Known OR Produced Identification
Type of Identiflicationq
r �`���%
LASHAI IN
Public -State of Florida
Type of Identification
Produced 7
tictary
Expires Dec 20, 2018
Produced
Commission No.
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Commission No. (Seal)
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