HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA1z.-W
ALL'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �` Cea SCANNED Permit Number:
BY RECEIVED
St. Lucie County u b
9 Building permit Application MAR 2018
Planning and Development Services Permitting Department
Building and Code Regulation Division St, Lucie eeunty
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 III
Address:
Property Tax ID ff:1dI f—%D�—pOs]— OOb ^s Lot No.
Site Plan Name: Block No.
Project'Name: 4=-e
Setbacks Front Back: Right Side: LeftSide:
l2eP t_+�c-; �r�orJT
HVAC I _J Gas Tank
Electric ElPlumbing
Total Sq. Ft of Construction:
Cost of Construction: $ Z7`�
1��12 -zrwpa.<�
Piping L_JShutters []Windows/Doors
nklers Generator 1:1 Roof
SgI7Ft.
. of First Floor: _
Utilities: I �lSewer 0Septic
Building Height:
Roof pitch
'OWNER/LESSEE
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CONTRACTOR
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Name:
Address G3E
Company:-AatAfNT/2F!
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City: f0fef 011546?Stater_
Zip Code: Fax:
Phone No. - — yeh5l
Address: [3t61 zQ 07-
Al
City: P/9C
Zip Coder 50
Phone No. 56,/ ;;5 53
State: EL_
Fax:
% %D�_
142
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEIVIPNT��CONSTRf.�CTIQN�LIEN`LAU_U
INFOIt.MAT10N
� � � � � t � 4 r
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
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.
no
e the permit holr/er to build the subject structure
or and covenants that may restrict or prohibit such
deed for any restrictions which may apply.
In consideration of the granting of this requested permit, 1 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 recomilog your Notice" f Commencement.
6f
Ignature'of tier/ Lessee/Contractor as Agent for Owner
ature Contractor/License Holder
STATE O ORI
COUNTY OFF,>t
STATE OF FLORJPA
COUNTY_
_OF��,wGA�
The orging instrument was acknowledg d before me
tnh�is,I day of �1�cu t n._, 20� by
The forgoing instrument was acknowledge before me
this � day of /�E 2017 by
Co (ec ka_-, "
Natine of person Ing statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification ;"
Type of Identification
r uced
Produced
(Si a ure of Not
(Signatur Notary ublic-State lorida )
JULIE BARRETT
„r: NotaryPublic fFlorida
Co fission No. ��:' ffMin�
o1p, ev ANGELAYOUNG
r a+PU c
Commission No. My CGMMI�I9d)kF951069
mmission # GG 43242
My Comm. Expires Sep 28, 2022
r .- "'r�
Nr Qe EXPIRES:Apol 12.2020
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--_ - - -- —.- BondedthroughNational Notary Assn.
BOAd.d ituu evdBetNamry 6eMws
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DATE
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DATE
COMPLETED
Rev. 8/2/17