HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE'_, FOR APPLICAmON TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
_ucie 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: �-6CC 72 64t ,
r .
NAM �.
1,111
k .. .. -. -
Address: 7g�c! sA-lil�2� rLQDk �2_ Sf L VCle l Ft -
Legal Description: /A,5CWW— PLl�YI%7-X-,P?0V - L07--'16�/Y�f�
33a�-5da- aWS ada-a
Property Tax ID #: Lot No. -
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
lgl
b
Additional work to e pertormed under this permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters -Windows/Doors
v Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First.Floor:
Cost of Construction: $ lS&')d Utilities] —*-.Sewer _Septic Building Height:
IN low
N me"'�� F"1(JeG`'6,r7i2�<A;
Name: �` '(,cJ1cG,+9»� <.
Companjj Lut L /AJG
Address 7fS� l:,, SANG E 11aD p
CState:_
Address:11E4 112,'eeAl 7
Zip Code:Fax:
City: State: �L
Phone No. 11a - 3y a- 6ga1
Zip Code: 3Yg6*.3 Fax: 772 -879 -9b 22
E-Mail:
Phone No. `7 72 - ZO/ — g(' 0
E-Mail: /lj6l�CEfC3LC.l J Q 6UZ49tJu1?J--,"
Fill in fee simple Title Holder on next page (if different
State or County License:
from the Owner listed above)
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'O.wners 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 ofthis 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 concurren.cy 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.
ignatur of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5-\r, I.y c�
COUNTY OF S k • i�oc �
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
thisAA day of 20� by
this day of . O► JfN , 26A by -
0a
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary P lic- State of Florida)
(Signature of Notaryublic-State of Florida )
Personally Known OR Pro u VENS Ida
ersonally Known i ti
Type of Identification Pro „ , >. `ate 1di 0
ype of Identification Pr uc �' L dQ GIVFN
c.,,
s• ' ��})rnlssion EE 85a76ps
Commission No. ��� utary
. Q N
n mmission No. �.�-� • : = otar� Public -State of floritta
9 Cr(oea$)fires Dec 18,2D1ti
8 ondedlhtoughNat'�ona�
o=, Commission #ff 858711
FF ��p`
E OFF
Bonded Through National .No<ar Assn.
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DATE
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DATE
COMPLETED
Rev. 7/2014