HomeMy WebLinkAboutBUILDING PERMIT APPLICATION•AII APPtLICABLE I FO UST BE COMP �ED FOR APPLICATION TO BE ACCEPTE4
Date: �6 Permit Number: I
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St. Lucie County.
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division 1512 — v o
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 1-Su,rSe o3/l1 . Dfe erferz
Legal Description: w,4, 7 13t / ® r 7
28 v 5 a 6
Property Tax ID#:
Site Plan Nam End �� on Pc,-r e'� r�
Project Name
Setbacks Front Back: Right Side: Left Side:_
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HDDiuonai worK to De perrormeo unaer tms perrnn— LneLK au utai appiy:
_Mechanical _Gas Tank "i Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: 2 `/ q,
Cost of Construction: $ 2. -tl `/$,��-
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Windows/Doors
Roof
Building Height:
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Name o
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Name: - ;a I ,.�I:�, �C1/'/ O S
Address:' ��- '� �'-� � f'
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Compariy. 0J .rb,
City: P C5
Zip Code: 3� Fax:
Phone No. 7%2 Zoi6l 6 ,Ff7
State:
Addres ;.42!41
City: S & State:_L
Zip Code: 3 4 9953 Fax:%%Zg%T 6%S1
Phone No. 4 2 '(577
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: I. VA:,
State or County License:
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Kanie:
_ 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 onthe jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
0100K
Signature of Owner/ Agent/ Lessee
Signature o itntractor/License Holder
STATE OF FLOR S �— �r_-
STATE O FLORIDA�&
COUNTY OF
COUNTY F
The f r oing instr e t s ackno dge befor e ^
this I
he f r oing instrument was acknowledg d before me
Qday
ay of
of�� by
Cr'2
CQ_' r �'J
(Name of person acknowled g)
(Name of person acknowledging )
(Signatur of ary Public- St ida)
(Signature of Nok&y Public- ate of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Ty a of Identificati n Produced
_Jjpeof Identification Produced
O��r PCB
Commission No. s°�* MyioAUut WAS Commission No. (Seal) ,
ExPIREs . ""'•••, 'ANGELA M-HUFF
°�a ! \October 14, 2G17 �! P„a,,,
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DATE
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