HomeMy WebLinkAboutBUILDING PERMIT APPILICATIONI - I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
i
St. Luce Coumy �7 _
RECEIVED
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial
MAY 10 1018
Permitting pe
St- Lucie County rent
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end &ne
Doi- DonCcn it ADDrI\rc BAc NT I nr'ATIr1A1: � ✓ � T! 1 IF/7
Address:
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Legal Description: I� y-) e-d—
PropertyTaxID
Site Plan Name: LJ�
Project Name: ':2peAo* u.A_.
Setbacks Front Back:
Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF.WORK . - i' ' �;
Corr�0ri�
0, �M .
CONSTRUCTION INFORMATION:
Q AC ri
Gas Tank ❑Gas Piping LJShutters ❑Windows/Doors
Electric LYJ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 411 I 6% Sq. Ft. of First Floor:
Cost of Construction: $ i Utilities:5ewer Septic Building Height:
OWNER/LESSEE:'
.
CONTRACTOR:'
Nam
Name:
Address.
H
Company::_�T%'M L
City: IA e2i c�d4 'U
Zip Code:(i(P alx:�zl�Dl/�-097
Phone NO.�G✓_42 J�1k:)
State:
1a-1)
Address:d')(F) -S t1Poeliei
at)
City: P/P_/,--z
Zip Code: 30'941.5
Phone No. -//1,3
State:_
Fax:
0
E-Mail: 1Gr M 67 l
Fill in fe simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: j� Pl(S I d1)55
60'+-1
State or County License: 2
(
n;Ly4DI
Y os r)
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
r
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFQRMATION: =
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ 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
is in lict
which con with any applicable Home Owners Association rules, bylaws or an 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
WARNINGIOWN R: Your failure to Record a Notice of Commencement may result in your paying twice for
improve s to y urproperty. A Notice of Commencement must be recorded and posted on the jobsite
before t in ction. If you intend to obta' financing, consult with lender or an ttorney before
omm ncwo or recording our Notice of ommenc ent.
Signa re of, Agent for owner
Signat o o tractor/ ices older
STATE OF LwOnee7rQLessee/Contracrt_oras
5 OF FLORJD�� f
COUNTYOFJLQ_J n Ee 1
UNTY OF� Q rX U
The f oing instr fient wa acknowledged before me
The f r oing instryrgent wa acknowledged before me
this o�layof� r .20�by
this dayof �r%1 .20�by
N f person aking statement
so ally Known _� OR Produced Identification
Name of perso aking statement
Per n ly Known �O ed Identification
e f I entification
Ty a of a ti Lion •i a�,�� DgNIELLEA. ROBRAILL
trodu
*A'•., ANIELLE A. ROBITAILLE
r duce ',. MYCOMMISSION#GG 077
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MY COMMISSION#GG 077751F.,,,.op
EXPIRES: June 26, 2021
•'R;fb••• Balled thou Noia7 Pu66cu
EXPIRES: June 26,2021
(Signature of Notary Pun
Signature of Notary Public- State of Florida )
Commission Nr / l (Seal)
Commission NA ? (Seal)
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DATE
QI
RECEIVED
Igl8�
DATE
COMPLETED
Rev.8/2/17