HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONe
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
SCANNED Permit Number: _W6 'K — ()-� gb
BY RIECErVED
St. Lucie County / '
Building Permit Application AVG 3 0.20V
Planning and Development Services Permitting Departr - -
Building and Code Regulation Division St, Lucie Coup�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line RewuAi-fA
Address:
Legal Description:
5'
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: 0
Setbacks Front Back: Right Side: _ Left Side:
-TV6
7-0
)1VTJ_1
M0.16-tU
Total Sq. Ft of Construction:
Cost of Construction: $%:7-q
S Ft of First Floor:
Utilities.-cr) Sewer 0 Septic
City: 'tBFA15E�� 1405� State: ELL
Zip Code: 7 Fax:
Phone No.913— R qO - 3�3 e-3
E-Mail: 04—��9_Asqb�)A IS 10 ^ L ctm
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
Name:
Building Height:
77I_0P1Pe7
Company: V8TWCAMrr00'= --'�CU7744—LON &.4 L"
Address: I-J- 0Q)0/W5/?_8-9_&7-
City: PeeLtAglUg 13t--_Ag,,f State: FL
Zip Code: ��?30 &� Fax-.75y_q-1q:7T&VC)
Phone No. -7,T-(/— 3D 30
E-Mail: J�WFI_ 0,9,4-n4-!-=�-r. CeAl
State or County License:C a C /-WS390
If value of construction is $2SOO or more, a RECORDED Notice of Commencement is required.
Applicable I MORTGAGE COMPANY: — Not Applicable
Name: a m e:
I
Address: Add .ss:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Address:
City:
Zip: Phone:
—Not Applicable
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con4ict 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 your Notice of Commencement.
2 � �/� --:: I -
Sign 3C f d�jnur/ Lessee/Contractor as Agent for Owner
SikmffuFe of Contractor/License—Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF 1?(ACA&)A-/2A
COUNTYOF
The oing instrument was acknowledged before me
f9
The f ing instrument was acknowledged before me
09day
this day of 314-Ile- 26Lb by
this of _'314 ,%JEF� 2o-LBby
8LgA79� 7_�+OIZ-fA�
Name of person making statement
Name of person making statement
Personally Known _V OR Produced Identification.
Personally Known OR Produced Identification
Type of Identification
Type of clentificatioK
Produ
Produced I!q
'Ry pg'e, PATRICIABRITIDN
(Signature of Notary Public- State of F4 WTC0MMM8I0N11FqW;ture
MaM:MffchZ,2MD
of Notary Public- State of Florida
1.Zir"
Commission No. BvidAm"IRRWIfty
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tb'Fffmission NJ:? WZ="0N#FF974=
EMRESAWM22.202D
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0/5(1,0
Rev. 8/2/17