HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOWAPPLICATION TO BE ACCEPTED
Date: �' I SCANNED Permit Number:
BY
St. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
Address:
Legal Qq:
Site Plan Name:
Project Name:
Setbacks Front Back:
4s6 - 5�5`4(
Building Permit Application
RIX-aft
MAY 18 Zola
PtneRUn® e� nment
ee W�a ntr
Commercial r— Residential
Right Side: Left Side:
Block No.
_Mechanical =Gas Tank _Gas Piping _Shutters ' —Windows/Doors
_ Electric _ Plumbing _Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1 H14 Sq. Ft. of First Floor:
e
Cost of Construction: $ o10C16 Utilities: —Sewer _Septic Building Height: \D
OWNER/LESSEE:
CO,Ni 16ACTi6 .
Name cLo�. < k
ame: u
Address: 1\.)rN tIKt F22�
1
any: c+� � (—
City: F State: P�
Zip Code: 3L-(S'5Fax:
Phone No.
Address: LIM
City: RoA >+«•e State: f2I
Zip Code: 3i�S� �. Fax: >;?
PhoneNo
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail PJ )
c . • CG
State or County License C
C-US 8,.{ 05—
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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
which 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.
�by
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 Corn encement may result in your paying twice for
improvements to your property. A Notice of Commenceme must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing onsult with lender or an attorney before
commencin ork or recordingour Notice of Commenceme t.
ev.
SUPPLEMENTAL CONSTRUCTION ICN LAW INFORMATION::
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: .:Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of n r Lessee/Contractor as Agent for Owner
$i na i e of ontractor/License Holder
STATE OF FLO IDA 1
� M_(
STAT OF FLORIDA
S')-•e-
COUNTY OF rI h_
COUN OF
The forgoing instrument was acknowledged before me
The forgoing instrum nt was acknowledged before me
this (� day of � 20�by
this �`` day of � 20 Prby
�?on Ga,
(Nara of person acknowledging)
(Name f erson acknowledging )
(Si atu o ary ublic- State of Florl )
(Si atu lorida )
Personally Known 4deLA
ersonally Known OR Produced Identification
,, HAHNA INGAAfvT—
Type of Identification �'�^„
ype of Identification
Produced � o's Notary