HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEh _:OR APPLICATION TO BE ACCEPTED
Date: 1-a °j- I `f SCANNED Permit Number: �i 1 c61ao
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: uf&kf 14crAdc✓ (ra
Address:`l a0 i�/en¢ukl✓ ,line P�SL 3�yFf6
Legal Description:
Property Tax ID #: �J�J a -7 — 5,0 I -'060 " Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
c�Ikrce � �0. I -e1e " �.c�-�� i��k✓ rc./� ii/ec.tJ
Aciclltlonal work to be performea un ert is permit - check all tat apply:
_Mechanical _Gas Tank _Gas,Piping _Shutters —Windows/Doors,
_Electric zplumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction'.$ e �Co-C-) Utilities: _Sewer _Septic Building Height:
Name Me- ✓Mci/I We/C-4i.
:'Name: �!(a6aLj4 •.
p
Address: ,2;?0 (d/"JCU/6'* J�an'e %
Company:
City: S L Stater/
Address: -vt 3 _ SvJ T t/O✓` 1' v
Zip Cade: 3??,f q Fi Fax:
`� Phone No. 10 - 3yd -- S- ere/ /
City: 5 L State:
Zip Coder `f qs 3 Fax: 170� $Z9
E-Mail:
Phone No 7)1_ S`7`=- ,� 1-1
Fill in fee simple Title Holder on next page ( if different
E-Mail_P%twlb!lb o 6D G1
State or County License 57AZk C47CILtMa S
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 CountyY 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 vour Notice of Commencement.
Signa re of Owner/Agent/ Lessee/Contractor
Signatur f Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sk.,L
COUNTYOF
The forgoing instrument was acknowledgged before me
The forggoing instrum�@e\nt s acknowledged before me
may ZrV
thisa5 dayof Nd� 2014 by
this of ' IVO 20A by
Sa Anne as lDA
Sd W.'& lbo%�
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Pu c-State of Florida)
(Signature of Notary Publi -State of Florida )
Personally Known OR Produced Ide "Ott a
Personally Known OR Produ .e on
Type of Identification ^ N. Slate
fl � •,
Type of Identification pEPNNP State of FtOZ�tB
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Produced V F°b Pe 13 64
Produced acv pUbtic' 0
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Commission No. •� � TS`0b
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Commission No. C' �• • cr� Y �°mm pe # boo Ott Assn.
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Rev.//2U14