HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1lih SCANNED Permit Number:
BY
L rr
fit. Lucie County RECEIVED
Building Permit Application Nov 0111'201
Planning and Development Services
mitting Department
Building and Code Regulation Division PerSt. Lucie County
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
PROPOSED IMPROVEMENT LOCATION;
Address: (DNLIO -
Legal Description:
n
Wr 4A Ct
t
Property Tax ID #: 0000 — 000 — R Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[I)ETAILfD'DESCRIPTIO"OR K s'. III
acnAMp 3phase mekr COX) Cinrie. ota
CONSTRUCTION INFORMATION
..uwuU11d1WUinwuc envnnau unuei unbpe[rnn—cnecxau apply:
11HVAC Gas Tank Gas Piping _ Shutters
ectric 0 Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ li 01)6.00
S Ft. of First Floor: _
Utilities: Sewer Septic
❑ Windows/Doors
11 Roof = Roof pitch
Building Height:
OWNER/LESSEE
CONTRACTOR:
Name
Name: �,b(>eS 1E.
ftk
IGs✓
Address:
Company: it-fwo—
F—iecAr,
a
City: State: _
Zip Code: Fax:
Phone No.
Address: 1010 IA M Cd u1AU el c
City:
Zip Code: NU
Phone No. I la- )i(p('
State:
Fax: 1761'y(pI'iI(p
S33 49
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: .(]_=Srnn+t1lA
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Corn
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State or County License: _
EC 13DOILaq 3 i
i
it value or construction is 5Z500 or more, a RECORDED Notice of Commencement is required. i II
SUPPLEIVIENTYALaCONSTRUCTION;LIENNN LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable
Na rrte—,cry
MORTGAGE COMPANY:
_ Not Applicable
Address. �`
Ad rles
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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 your Notice of Commencement.
r
Sig a e of Owner/ Lessee/Contractor as Agent for Owner
Signa r f Contractor/License Holder
STATE FLORIDA
COUNTY F O5�.1.,...
STATE OF
_o ,
COUNTY OFORIDA
The for oing instrument was acknowledged before me
F
The forgoing instrumeniLwas acknowledged before me
this day of 1.PSV 20tl by
this$ day of (wJ 201$ by
SA xylq�= P
Name f person making statement
Name of person making statement
Personally Kno n OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(' ture of Notary Public- State o Florida)
of Notary Public-
(Signature_
t e o_ a,)."..,r
J•
•
Commission No., ,(Seal)HNA INGRAM
Commission No.
•'P LASHAHNAINGRAM
"" "&%'•, Motary(6.ea"IN State of Florida C
A Notary Public - State of Florida
;. „ „. My Comm. Expires Dec 20, 2018
�. : a •_ My Comm. Expires Dec 20, 2018
'"q' o'V Comml^lion 4 FF 177249
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Natincal?lalary Assr,
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Rev.8/2/17