HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ''cif'- Permit Number:
RECEIVED
Building Permit applicati
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Planning and Development Services
Building and Code Regulation Division j Lucie oul-It
2300 Virginia Avenue, Fort Pierce FL 34982 St-Lucie C �aa�ty '
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential -
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PERMIT APPLICATION FOR:
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Address: 35T'7 5� t ova �P_ rQ �' Pt eYte, 3 9 S1
Legal Description: !
Property Tax ID#: j 3 ii 000 noo6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: !
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DETA�GED DESCRI'l?U _N OF WORK s ti � F, , k -v �
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CONSTRUCTi:tON 'i FQRiUlAT10�,ti� k � g
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AC[ditionalworKtobepertormed under t is permit-check all that appy: i
_Mechanical _Gas Tank —Gas Piping —Shutters Windows/Doors
v"'Eiectric Plumbing _ Sprinklers —Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction: $ JRS7_ Utilities: _Sewer _Septic Building height:
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Name ti r'SC k i ev Name: "Tri r'(Zil'afe IS
Address: rj SW G vovl14u-. Company: =Vo(JG .S S L LC
City: oY $r L GI C.I"e State: E( Address: 2 ;C-'J r f`
Zip Code: 34 9 g 3 Fax: City: PT St f.ri'c ("e Stater(
Phone No. '3 16 c – 2a L q Zip Code: :S Y ,? I Fax:
E-Mail: �o 0)O7_ S �,p r Z e Va hdo_ t Styr Phone No '7? -- C U! "' FC 5 S
Fill in fee simple Title Holder on n pe ax next (if different E-Mail -}T od ey5 ti c a L6 e-,fa,
from the Owner listed above) State or County License ' G �� t( SSI
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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 ithe 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 our Notice of Commencement.
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Signatu=ower Le ee/Contractor as Agent for Owner Signature Co ra o icenseHolder
STATERI STATE OF FLORIDA:51
COUNTY OF A o . COUNTY OF
The forgoing instrApent w s acknowledged before me The forgoing instrument wa acknowledged before me
this day of �,20 Ito by this_�L day of 20IL,by
(Name of p on acknowledging) (Name of persWn acknowledging)%
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(— igrikure of Notary Publi - tate of Florida JSInatiure of Notary Publi -St a of Florida}
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Personally Known OR Produced Identification Personally Known, OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No.
• •°= Notar 'HAHNA INS
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COUNTER __ Nota y PMYIFSWe of F oJfINNS
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DATE My Comm.Expires Dec 20 2018
?F _ o�° C mmission#FF 177 49
RECEIVED �' y
DATE i ac S n.
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COMPLETED
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