HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPLICABLE INFO MUST BE COMPL'__ -)FOR APPLICATION TO BE ACCEPTED -
Date: �111 `�� SCANNED Permit Number. 1` waRR K? 1 11P
�—BY �� -
St. Lucie County
Building Permit Application RECEIVED
Planning and Development Services I " J, . 17 ^8!9
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Lune County, Permitting�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �� x:. -,I
Address:
Ira
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
RETAILED DESCRIPTION OF WORK:.
x
S14b IIAe w4y-e x&4W i n /o�I
IN
onaiworKcoDe
HVAC
errormea
unaerimsperm¢-cnecKau
Gas Tank [_]Gas Piping
appry:
_ Shutters
Windows/Doors
Electric
Plumbing
Sprinklers
Generator
0
Roof
=
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:$ �e,00de
5 Ft. of First Floor: _
Utilities:cnSewer 0Septic
Building Height:
OWNERAESSEE
_ _2me
CONTRACTOR:
-
Name
Name:
Address:
Company: /yCAfree C0A
City:
Zip Code: 0 Fax:
Phone No-1 -� -C�- 5
State:
�77a 5 `0
S �J
Address: PD.- I& zG
City: OKG«{ %P-e State: OL_
Zip Code: Ny Fax:
Phone No. 772 -WO Z_/ S� &S/
E-Mail: 12
I
.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: /'J--b2n=q ®GYa1 -G'Di�
State or County License: COC D(p / 0,73
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIQN:
DESIGNER/ENGINEER - : Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: Al, EN t/1AW c is
_
Name:
Address: u—'rohit
Address:
—via
City: State:
City: State:
Zip:, f-f/.h 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.
St. Lucie County makes no representation that is granting a permit will authorize the permit1hdlder 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 orj;�cording your Notice of Commencement.
!/C�-�
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ,
STATE OF FLORIDA
COUNTY OF Ian Ri/�
COUNTY OF X.1
The �jo g instru fient was acknowledged before me
The forgoing instrument was acknowledged before me
this r day of 'i kM2 20� by
this / day of Ta t/2 20-If by
C-1-e✓) `7_ p-,
STRe
e ass
Name of pers5pr6aking statement
Name of pers n making statement
Personally Known t cation
Personall Kn wn � OR Produced Identification
Type of Identification JUUE saea.r
ype o Identification
_
Produced :: A ^ •; Notary Public - State or %rid.
Produced
•..�• oa:,; LOMMISSion # GG 243242
My Comm. Expires Sep 28, 2022
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Bonded through National Notary Assn.
ignature of Notary
Signature of Notary P
>�'."�.. JULI. 3A<..TT
Notary�ai)
� Notary Public State of Florida
Commission No.
State of Florida
Commission No. ShanrronLR@gp 11
._;•,� •vim.: C.mmisslor. a GG 243242
...:.P•«`:' My ,'.: err•, Expires Sep 28, 2022
y My CotnrnliWmr G 24a323
q F.xisim W1312022
3urdec :':FtN ;h .::,ara. Votary Assn.
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DATE
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COMPLETED
_
Rev. 8/2/17