HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (a SCANNED Permit Number: �d /a
BY
St. Lucie County [RECEIVEn
s
Building Permit Applicotion JUN 2 6 2M
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
PERMIT APPLICATION FOR: kc)? *-VA,+) "
Legal Description:
_i /Ih—
Site Plan Name:
Project Name:
Setbacks Front Back:
�S l —Oco—Z
Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
/ D O "^ --=
Cost f-Con"siT,ucfion 5 == da0a UtiliL,(es: _Sewer _Septic
Permitting L.,'_p rtr;;ent
St. FL
Lot No.
Block No.
-Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
amp£. lam( IA AY✓
Name:
Address:-3 2-" OU kW u 1i l A
JJ�lo0,r
Company:
City: -I — R eey rz
Zip Code: 3gyjLP_j Fax:
Phone No. �' To l — 3g - 330-7
State: 1�7)
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: '6v 67T'6V V41d m. C_Dw"
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEME TAL CONSTRUCTION I LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applicatiorl' is hereby made to obiain 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
comnpeftcing,work or recording your Notice of Commencement.
ner/Lessee,- .tr. do'ras . er
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 15je. Lwc•2,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisQ& day of 20J? by
this_dayof ,20_ by
De_bm A1nn Lciver
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Ideytification
coLLfc
Type of Identification
Produced
Produced
(Signature of Notary Publi Stas,"gf FIoridqATTHEvvADAMFALco
(Signature of Notary Public- State of Florida )
��•`�'�':5 Notary Public - State of Flai
Commission No.f°. cyml4(SLSajr,sston%Gc09fid92
Comm. Euires Mar 24,2021
Commission No. (Seal)
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