HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i q
Date: SCANNED Permit Number: ofoo_
BY
c .T 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 V Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
,e II Address: —7-329 GCCf%
.l• Legal Description:
Y IIProperty
Tax ID #: 'r
'�[OOt
• OS$
Oo 01 . Ow
I
Lot No.
Site Plan Name:
Block No.
Project Name: 1J_ /G if &1/1
Setbacks Front Back:
Right Side:
Aaaitional worK to oe errormea under ims perms—cneUK z
�HVAC Gas Tank ❑Gas Piping
Electric 0 PlumbintO X 35-, = `17Oiag �Sprinkl
Total Sq. Ft of Construction: �O
Cost of Construction: $ � i%�J�� Utilities:
i
Left Side:
n6/�uJ.t�j 16nre
(Shutters ❑Windows/Doors
IGenerator E—] Roof Roof pitch
of First Floor:
Sewer Septic Building Height:
�'OUVNER� LESSEE.:
CONTRA 9R•:
�
Name J r 11 6\ I
Name: 57GAa/
Address:-7 _VV kNACio feI
Company:.P✓
City: ice State:
Zip Code: X.
Phone No. F
Address:
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City: .C_ C
Zip Code:
Phone No. 90,JTT73
tat
Fax:
E-Mail: �r W •Lli
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: �6✓�i1n/C�eZ�tJ
LU>�
State r County License: EGG/S/.SOZY
If value of construction is 52500 or more, a RECORDED Notice at commencement is requirea.
- %_2
SUPPLEMENTAL CONSTRUCTL� LLEN LAW I
FORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_Not Applicable '
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_Not Applicable
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. r
St. Lucie County makes no representation that Is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or andpcovenants 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 1 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
commencingwork or recordingour Notice of Commencement.
Rev.8/2/17
r18
y
Signatur of Owner Lessee/ ontractor as Agent for Owner
Sigffa—fiure of on ractor/License Holder
STATE OF FLORIDA
STATE OFFLORIDA
COUNTY OF T- L�UGL�
COUNTY OF �t�il�lrii�
The for oing instrument ��([as� acknowledged before me
The forgoing instrument was acknowledged before me
this�dayof bt'tPA'ft7t'E ,2018 by
thiso2 da�2�� by
U Nk LI
Name of person making statement
�
Name p�
Personally Known OR Produced Identification
Personally Known q�p duQbBja�EUN(a�0eetmt Florida
Type of Identification
Type of Identification f- � Trevor Gross
My 2610e7
Produced FL D27v- LrG
s
Produced IC�mina' 2022
(Signay re f Nota P i a Flo 'd
i of Notary Public- State of Florida j
Commission No. FP "' '�1�$ea'fjApIAGA9RIELLA0R0
mature
C�o ission No. (Seal)
,e Nota