HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA/W INFO MUST BE COMPLETED FORAPPLICATION TO BE ACCEPTED
Date: �` / ce Permit Number:
RECEOVED-
SEP 2 6 2016
Building Per it Application
Planning and,Development Services
Building and Code Regulation Division
2300 Virginia,Avenue,Fort Pierce FL 34982
Phone:(7721)462-1553 Fax: (772)462-1578 , Commercial Residential
PERMIT APPLICATION FOR: To Select from drop ox, click arrow at the end of line D�.i
F - F
Address: (`k 3 IJ w woes!-5„ G v
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Legal Description: pod '40(A,T- tl 9AWU-%•eV--V0l (,t", �- 1
Property Tax ID#: LJ Li iib O S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�TS CI►( � A/�G S O O K
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ACICIrtionalworl(toDenerformed under this permit—check a11 appy:
❑HVAC Gas Tank Gas Piping _Shutters O Windows/Doors
Electric ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Ft.of First Floor:
Cost of Construction:$ kO Y S Utilitie : _Sewer E]Septic Building Height:
Name , pl l— C=P-1 Name: Peter Cafaro III
Address:. •) 19'3,0W1 �` t� Company: Lowe's Home Centers, LLC
City:' JPA State._ Address: P.O- Box 781993
Zip Code: 3�t4Q u `•:Fax: City: Orladno State:FL
Phone N.o.-.14 Z' .' 60�. Zip Code: 32878-1993 Fax:
E-Mail: Phone No. _77,2 -q1<9- 3(P45
Fill in feesimple Title Holder on next page(if different E-Mail: 'SPG_ L
from the Owner listed above) State or County License: CGC1508417
ff value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW)wORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: l Name:
Address: Address:
City: State: I City: State:
Zip: Phone: I Zip: Phone:
r
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: Not Applicable
Name: I Name:
Address: Address: i
City: City:
Zip: I Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is here y made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to he issuance of a permit.
St.Lucie County makes no representation that is granting a p rmit will authorize the permit holder to build the subject structure
which is in,conflict with any applicable Home Owners Associa ion 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 C des and St. Lucie County Amendments.
The following building permit applications are exempt from u dergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,scr en rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notic of Commencement may result in your paying twice for
improvements to your propert . A Notice of Comm ncement must be recorded and posted on the jobsite
before the first inspec ' yo intend to obtain fi ancing, consult with lender o orney before
commencin wor recordi Notice of Com encement.
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Signatu'e of / ent/Les a Signature o Contra r/ nse Hol
STATE�OF FLORI STATE OF FLORI A
i COUNTY OF SLC COUNTY OF SLC
Tbhe forgoing instrumept was gcknowled e foret me I The forsoing instrurrgnt was acknowledge ore me
1 this_Z3!�day of _f*J!+ ' 2OL106Y thi5/o*day of .56194 20QEDby
IPeter Cafara III i Peter Cafaro III
it (Name of p ackno ging) i (Name of person ac in
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(Signat6re of Notary Public-Sta a of Florida) I (Signature of'Notary Public-State of Florida)
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Personally Known X OR Produced Identification Personally Known OR Produced Identification
Type of identification Produced Type of Identification Produced i
,,,,1111,,., ommission No. ,11111111
i Commission No. (Se&IhCH BOCOOK }. BOCOOK
I . Notary Public - State of Florida
Notary Public -Stato of Flon a �"
spoee Mar ?.
I +f ?? Comm�i1asEoa EE 176869 •F °•' Commiss.nn a EE 176869
OF FI,� '1�1111111�1�
Revised 07/15/20 "111111' Bondco Tnrouon National Notary Asn Bonded Througn Nv I;Ona!Notary Assn,
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