HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE 114FO MU BE COMPLETED F('PPLICATIONTA BE ACCEPTED
Date: I
Permit Number:
SCANNED
BY
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 Residential
PERMIT APPLICATION FOR: (PC�APICAi C'�,4/1 c'o✓
Address: (0®d, / w,&
Legal Description:
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Property Tax ID #: ���a�` (pO�' ��r y —/j�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
L/Ke /zd� LIILe 2•� T<n /6 S�� C�Ans��C'
Additional work to bepe orme under tis permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing —Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �2 .S)� o Utilities: —Sewer —Septic Building Height:
Name i�i rr�e� u' ri Name:c,aInrnCurt tS•:SIMrnorl 5
Address' W6 e %%lcrr /n�, CAri3%I7b?9 r,
/.(�i1 Ompany.�"�.L�S-r6`m�'!�F.IIr �4S'�ernc ItiG
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City: State Addresv;,, l'fi,15' 5�.:`jiil(raao_Qaen Dr
Zip Code: Fax: City: 'Poe.-r ST UCIe— State: FL.
Phone No. Zip Code: 3495,2, Fax: 77.1 335- ) U %
E-Mail: Phone No. 77,E 33,5 -3o 3 i
Fill in fee simple Title Holder on next page ( if different E-Mail: c.0 taor, s u t V ao I CM
from the Owner listed above) State or County License: CAC 0 5 1 R 10 - S4CL1e '
If value of construction is2.SWor more, a RECORDED Notice of Commencement is required.
75D0
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 your Notice of Commencement.
Signature of Owner/Agent/ Lessee
Signature of Contractor/L cense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTYOF
The forgoing instrum�yent was acknowledged before me
this a�/dayof Alaw-e� 20-,&/by
The forgoing instrument was acknowledged before me
this ou/.dayof 20/Vby '
l 2T/J i lit a'r -
�� r LPAgy djr S' ,
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Publi ate of Florida)
(Signature of Notary Public-S t Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
/9 CHRISTINER ENGLIS
Commission Nos—x L��a�� MY COMMISSIONIEEB59
# EXPIRES:Apri14,201
EXPIRES:
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Type of Identification Produced o'M P/r.���s � g curUgh
i p y COMMISSION 4 EE 859284
"commission No. ��O m'o @al EXPIRES:Apti14,2017
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