HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL INFO MUST BE,1 ;PLETED FOR gPPLICATION TO BE,ACCEI-,. N t '
Date: SCANNED RE . m er: Ir
D
BY
s:Iv St. Lucie Coui ity JAN 15 2019 -- E .
.... S..Lucie Cpun ,Per fitting
.._ Buildin -
Planning and Development Services
Building and Code Regulation Division uc Co ty, i in
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ,/ Residential
PERMIT APPLICATION FOR:
Address: to •7A S. %. 5: `�. r,
Legal Description: (.,of I LPii.IL .2 S,j lL tT�rwwLt9°o.Cs
Property Tax ID #: 3 c(iffSrr - Sol -00Z0- DOO -') Lot No.
Site Plan Name:. t% ems- - - U,ae t5 Block No. ..
Project Name: _Sr.• LLJcrw 60ci= br d,^ i2a%�w
Setbacks Front Back: Right Sider Left Side:
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v-vr Modv/..� bud/cat. ..
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AddiUona wor to e performed un ert is permit- check'all t atappy:
_Mechanical _Gas Tank _ Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing —Sprinklers ` _ Generator _, Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ . `4, .330 °O Utilities: —Sewer _Septic Building Height:
G'
Narne - -IN eaA IS Name: y1ti5 UR a5T '
Address: co� . ).)E nZ,d S-t Company:-' l,�cey (bW'5re. cTi0wJ (:b
City: tO^^+ arm .. State:- Address:_ Y16Y- aA-rVQ
Zip Code: 33 t Q,7— Fax: City: Fr . P State:
Phone No. 3C»- cl�- 93 00 Zip Code: �FR S z Fax• --
,!`
E-Mail: Apoonge Phone No -77 Li61-4rS$—
Fill in fee simple Title Holder on next page ( if different E-Mailer i rtc�-5 ,o u�Lwo, ems-
from the Owner listed above) State or County Licensee
If value of construction is 2500 or more, a RECORDED Notice of Commencement
is required.
ob% q1
a�i
DESIGNER/ENGINEER: _ Not Applicable r MORTGAGE COMPANY: _ Not Applicable
Name: A rc0-L%+e-Aion.c- Name:
Address: gob l7c u avvAve- Address:
City: 7 •pee.-Ce State: City: State:
Zip: cl,5D Phone 77 L - W O - 7 7 S-/ Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 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 our Notice of Commencement.
ev.
Sig tna�u`re of Owner/ Lessee/Contractor as Agent for Owner SignaturrFFLORIDA
ntract
or/License Holder
STATE OF FLORIDA
STATE
COUNTY OF Sr. �.�• cam
COUNTY OF G u e,t�
The fo going instr ment was acknowledged before me
�
acknowledged
The forgoing instru ent was acknowledged before me
this day of 20� by
this � day of
Name of person MaKing statement.
Name of person making statement.
/
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification
Type of Identi ion
Produced `�
Produced
(Signature of Nota N
ry'rl.NIELSEN
Florida-(yotarypublitateofF
Commission No.ssiAe�igG2o748a
KAREN S. NIELSEN
AgJune
Commission No.��otary Publimmission
ExpiresCommision
12,
GG 207484
•;?o, �o�,� My Commission Expires
2022
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