HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: It), `z- 7 • / SCA Permit Number:
NNED
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
APPLICATIONPERMIT FOR:
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Address: (27 to ,✓��4-iv�2r' C' .
Legal Description:
Property Tax ID #: `( �-� (06 ' Oo 2,5 ' 000 _ 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
itional work to
be pertormed under
this permit -check
all that apply:
_Mechanical
_ Gas Tank
_'Gas Piping
_ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ SN Utilities: _ Sewer Septic
Windows/Doors
_ Roof
Building Height:
Name a li1 f-i�L2ylk� •D,?-A,C['o .
Name:
Address:`;l Z 79 N !^Jr¢r 0-
Company: !L ° G1,�--67(�-1L LAX,
n
`
City: Q�� � Ct'�-�1 State: '�-
FOLD C-b H
- 2 SC- Fri
Address: Q,,
Zip Code: `; q 0190 Fax: fJ
City: 64-r llru& State:
Phone No.
Zip Code: 3V9 SZ Fax: tj
E-Mail:
Phone No. -712
Fill in fee simple Title Holder on next page (if different
E-Mail: S}dG�S}'(le%a cG co �cMGi (•Cdlrv�
from the Owner listed above)
State or County Licenser I 1
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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:
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 and covenants that may restrict or such
or prohibit
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 our Notice of Commencement.
Signature f Owner/ gent/ Lessee
Signature of Co tractor/Li nse Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5k
COUNTY OF SS L u to
The. forgoing instrument was acknowledged before me
this 1. day of C� 20l` by
The for oing instrument was acknowledged before me
thisa� day ' 20 ILI by
,
of :a •
k.
(Name of person acknowledging)
(Name of per on acknowledging)
(Signature of Notary blic-State of Florida)
(Signature of Notary ublic- State of Florida )
Personally Known Oker uced I erg r
"
����. PRY P ,
Personally Known j2 Pro u e ' is tion
Type of Identification Pr dfi
Type of Identifica oli r A GtVFAI
= My Comm. Expires Dec 16, 2016
Commission No. 1.=- -, E °' C(SmOsion # EE 858761
' M Comm Ezc State Of Florida
Commission No. issio�(, , 2016
Bonded Through National Notary Assn.
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58
on,y hrou EE 61
9h National Notary
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COMPLETED
Rev. 7/2014