HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `' D .47. Permit Number:
SCANNED
BY
St. Lucie County
Building Permit
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
3ut
Commercial _
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,02
b��7oO�
xv&I/`i s.
' /JUL 10 2018
v/1 Permitting Department
Re ide5WAALicie COUrity, FL
Property Tax ID #: 7 14 ^ K(l ^ FJr/U Gil(/ f] Lot
Site Plan Name: Itl2 3 LpI
Project Name: Cb
Setbacks Front Back: Right Side: Left Side:
=Mech cal _ Gas Tank Gas Piping _Shutters ` _ Windows/Doors
lectric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq.-Ft.of Construction: ' Sq. Ft. of First Floor:
Cost of Construction: $ CN Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name AT
Name: � 0
Address: 90 DCeaA -Die-
Company: S
City: MIT?- I7 CP Y1 PKC.4 State:i1—
Zi C'O7�e�: �� Fax:
Phdn��� - )77-�
Address: 24ZO
City: CG State:_�r
Zip Code: Fax:,
Phone No Z
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail a C eC
State or ou ty Lic
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN W INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Namel
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: 4: State:
Zip:— Phone !L
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: 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 nori-residential use
WARNING TO OWNER: Your failure to Recoid 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 t inspection. If you intend to obtain financing, consult with lender or an attorney before
comm4ricing Work oflrecordine vour Notice of Commencement.
Signat a of wrier / Lessee/Contractor as Agen ;• Eli@
Sigriat a of ontractor/License Holder
, �••,,
S TE FLO
STA F FLORI
C OF
COUNTY OF
.fie,
The forgoing instr a as acknowledged bef m o
day
The fo ing mst was acknowledge�¢efor
oss g
this of 20by y�
this day of 20 by
a m
i \ %i r)
rna
(Name of person acknowledging)
mN
(Name of person acknowledging) ?3>
m2.
(Signature of Nottky Public -State of Florida)
(Signs ure of Notary blir' State of Florida)
Personally Kno OR Produced Identification
Personally Known OR Produced Identification
Type of Identi scat, p-
\ '
Type of Identi ca '
Produced itr
Produced ). + C�
�,
• Commission No. (Seal)
Commission No. (Seal) +
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