HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY `�1158 bJ�N�
• _ St. Lucie County
Building Permit Application
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDriMRROUENrENTLOCATION„
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Address: I �Gtnq illlxJ/Tumi5itg,
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Property Tax ID #: co—[ Q — oQ D�/Q
Lot No. $
Site Plan Name: Block No. 1ni
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIP�IOIt1lOF WQRK•`"`` "s'�'� ' �' ��` h � � r�,�w rya �< r" 'r ` ��,�, ;:
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rti na worhto e e orme un ert ispermit—c ec all apply:
�H C Gas Tank ❑Gas Piping Shutters ❑ Windows/Doors
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Electrlc 0 Plumbing Sprinklers Generator Roof Roof
pitch
Total Sq. Ft of Construction: SgI�Ft.I of First Floor:
Cost of Construction: $ Utilities: nSewer 0Septic Building Height:
OWNER/LESSEE J x
CONTRAGiOR,
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Name
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Name: WISQ11
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Address: 8
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Company: YYYNi C•
City: State: _EL-
Address: I43ao KW 4+*" Rheej-
Zip Code: Fax: QSLI- L432- rj3A
City: �' UnriSe Stater
Phone No. -l.1 2,- 02_12t
Zip Code: 55325 Fax: Q94 - Q 51-1333
E-Mail: Q•COM
Phone No.
Fill in feeTsimple Title Holder on next p ge ( if different
E-Mail: , h mP Q11 i5,com
State or County License: V
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ 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
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 or an attorney before
commencing work or recording vour Notice of Commencement.
Signa ' e of Owner/ sse Contractor as Agent for Owner
Signature of Contr ctor/Lice older
ST E OF FLORIDA �] S
STATE OF FLORIDA
COUNTY OF Y[7iOI cJft7C_l�
COUNTY OF �C2/G�Lbtzit yc�
The forgoing instr ent was acknowledged before me
this day of 20a by
The for oing instru nt was acknowledged before me
this � day of 20&by
W ec5 if/• Yocr>�er
/�L/�an ,/cau� /l�o/in�l�
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
Produce1d
(Signature of Notary Oublic&ate of Florida)
Pulilic-(of Florida)
Commission No. .••• •••••. SUZAN
Commission No. •r is"'_•••, SUZAN*.QWkNEZ
-••.••,- MYCOMMISSION#GG154331
-:
€@; `:= MY COMMISSION #GG154331
EXPIRES: February24, 2022
';: •••.. ;?_ EXPIRES: Febmary24, 2022
•'••.•.• '
'•.°FF;,••• Bon
led Thin Notary Public
Undermters
SEA TURTLE
REVIEWS
OR
PLAN
VEGETATION
MANGROVE
COUNTER
REVIEW
REVIEW
REV
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
6(/ tl0
COMPLETED
Rev.8/2/17