HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONl
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: / $ % Permit Number: V
SCANNED
BY
St. Lucie County OCI' -
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271019
Building Permit Applicatiorb
e
Development Services Planning and St. l i °9e
Co6't Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
Address:
Legal Description S L1c L/• �_ ,flt2p i1/
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Property Tax ID q: — — Lot No.
Site Plan Name: , i .G,,P)�i Block No.
Project Name: Lwh 15- 1/4-T-99 o
Setbacks Front - Back: Right Side: Left Side: -
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Ad diUona I wo rk to e e ormeu under tis permit - cneCK all apply:
❑HW Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing []Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: E!t� 0111!!� Sq. Ft. of First Floor:
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Cost Construction:$ 4 "��z7 Utilities: Sewer ❑Septic Building Height:
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Name &At'Ffra !�✓. J uG 9r"sr 62707i
Name: YPFv �xdJPA
Address: 13-1- I S0I , ✓cA SF Re IPA
Company: oe'er 0 9 7-
City:— State:
Address: �S • 6:7- -7AIV 6 T—
Zip Code: a"'?Ce Fax:%%1'a, o10 �
City: 57 A_AyZ-T State:_ L
Phone No, 99s-- 3'tl - 3y 5
Zip Code: =;�Z 9 5 7 Fax:
E-Mail:');+hAP- ff, h 18 061-Cctr✓I
Phone No. 7z
FIII in fee simple Title Holder on next page ( if different
E-Mail: fZio
State or County License: am sz%r5�
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. Rri 69
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DESIGNER/ENGINEER: _Not
Name:
Applicable
MORTGAGE COMPANY: _
Name:
Not Applicable
Address:
Address:
City: 7
Zip: Phone:
State:
City:
Zip: Phon :
State;
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not
Name:
Applicable
Address: iA
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 Count 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 Inder qlr an attorn y before
commencing work or recording vour Notice of Commencement. /, / W
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Sign ure of Owner/ Agent/A96see Signat re of C tractor cense HoI0 r
STATE OF FLORIDA STATE OF FLO IDA
COUNTY OF r e },I ,, e te COUNTY OF L Lae
The for ring Instrume t was acknowledged before me The forgP�pqing instrument was acknowledged before me
this I dayof Qlat 20 t9 by this _LF—day of fk. d& er" 2003by
_J0.,rte5 f,27 C,rr '4 R�'/ Ro b +- P D!.v. K&&r
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Public- State VFlorlda) (Signature of Notary Public- a of Florida )
Personally Known _A ^. OR Produced Identification Personally Known _ k OR Produced Identification _
Type of Identification Produced Type of Identification Produced
Commission No. "":.,, (`95W=LTAYLOR mmission No. "' ft : VEF(6 LTAYLOR
'•r �'' MYCONMWM#GG82 W ;« • » ",cowwSSiOPJitG0927pi?
Revised 07/15/2014
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