HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: SCANNED Permit Number: / 0 D C9 - 0 r `4co_3
By
St. Luce County
RECEIVED
Building Permit Application
Planning and Development Services JUN 18 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial __X_ R sifttEaull de NCH mty, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: to - ,
Legal Description: % O E / XZo
Property Tax ID#:y.201-//3-0001-OaO 9 Lot No.
Site Plan Name: o/ � Black No.
Project Name: au<Gi .iJ
Setbacks Front Back: Right Side: Left Side:
.DETAILED DECRIPTION°OF WORK.
CONSTRUCTION INFORMATION: ;
Additional work to be rmea unciertnispermit-check all apply:
HVAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
LllElectric OPlumbing Sprinklers 1:1Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /�� �Op- � o Utilities: Sewer Septic Building Height:
,E?WN Eli/LESSEE:
CONTRACTOR:
Na
Name:
Addres :
�nnC
Company:pm;&f Lca/
�1 • ��• �/Z.
City: State:
Zip Code: /!5a / q_ Fax:
Phone No. 9941- t145 o 4/79
Address:e4(L3 !I_ j�4
_A/ A" � /02-8
City:, 7�..t.o.Lc C�
Zip Code: 3#946
Phone No. V6/-�?777
State:'
Fax: 44i/-_?779
3704994
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: /y, i die a Pn, di -
L Q tcsfhi eaL . cam
State or County License: EC
SLC tl
/30d-Z-959
a S-
If value of construction Is 52500 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
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 an attorney before
commencin work r cordin our Notice of Commencement.
Az&�
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Rev.8/2/17
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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:
Sig re of Ow r/ Lessee/Contractor as Agent for Owner
Signa u e of Contrac License Holder
STATE OF FLORID
�T L.,L.(, G 1 fi
STATE OF FLORIDA
S^T !J � C I L
COUNTY OF
COUNTY OF
The fording instrum nt was acknowledged before me
�u,
The forgoing instrument was acknowledged before me
this � day of r/F . 20%Y by
this i 3r'day of 20 !G by
� I*C,a,Q�i i �.,.•� �,
m ; a ), P,, : dam.
Name of person making statement
Name of person making statement
Personally Known ✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�✓I�I.R•a.t�ecJ �Cc�a—�—r,'�
`-�l-�-ru�cJ . C' o
(Signature of Nota
-
(Signature of Notary Public- State of Florida )
r2�y'c"�pt MONICACASANA
Commission No.
i.`COmMssbn#Q$@iU073
Commission N . ••"ti�'�1:"` MONICACASANA ''SSeal)
F xOresJune8,2021
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Expires June 9,2021
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