HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE.ACCEPTED
Date: 6 t �� Permit Number: / �(2�
RECEIVED
Building Permit Application
Planning and Development Services N®V1`
2 ' 2016
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: To Select from dropbox, click arrow at the end of line
Address:
Legal Description: W" d*_5 aC RQAC CE I r3�y
Property Tax ID#: k5a 7- - 50 1 L-%_�y - Lot No.
Site Plan Name: Fowh :5P Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
C�N or�� 12 ptCao�o;�•- s 4- 1
d
Additional work toe nertormed under this permit_check all a p y:
.- ❑HVAC 1:1 Gas Tank ❑Gas Pi _Shutters ❑Windows/Doors
Piping
❑Electric r_1 Plumbing Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
,a
Cost of Construction:$ S�2 3 Utilities: _Sewer F]Septic Building Height:
k
0 Mm
cc '
Name �[)�^^ J'��� Name: Peter A Cafaro III
Address .1.3.lta_-'..N��- 'S (3.1,/� Company: Lowe's Home Centers, LLC
City:��- ." aR}- Stater- Address: P.O_ Box 781993
Zip Code:-3KR lf"l fax: '. City: Orladno State:FL
Phone No. -(c7 Zip Code: 32878-1993 Fax:
E-Mail: Phone No. 772_-1lJ8-3fa9 5C
Fill in feesimple Title Holder on next page(if different E-Mail: �pC�-<< Y°r'`.''
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.
i11
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: Not Applicable
I Name: Name:
( Address: Address: i
City: City:
Zip: Phone: Zip: Phone: j
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 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 inspec ' yo intend to obtain financing, consult with lender o orney before
commencin won recordi Notice of Commencement.
Signature of / ent/Les a Signature o Contra r/ rise Hol
STATE OF FLORI STATE OF FLORI A
COUNTY OF_SLC COUNTY OF SLC
The forgoing instrument-yvas 4cknowled e before me I The faraoing instrument was acknowledged)More me
this!Bay of NOV 20 y this�� ►day of �1pV 20�oy
I
Peter Cafaro[it Peter Cafaro III
(Name of packno� ging} - (Name of person ac In
(Signature of Notary Public-Sta a of Florida ) (Signature of Notary Public-State of Florida)
Personally Known X OR Produced Identification Personally Known x OR Produced Identification
i
Type of Identification Produced Type of Identification Produced
Commission No. "',"i"•. (SeMhCH BOCOOK ommission No. "
I
` k§MBOCOOK
.` Notary Public -State of Florida r+ •` Notary Public -Slate of Florida i
i _-- ^• "• VCnm�Expice�Mar • -
+. P' Commiss:on e
o<<`�P Commission #EE 176869 •.,,a�+�r�, EE 176869
Revised 0'17/15/20 �" Bonded Throuoh National Notary Assn ' Bonded Through N�;ona'Notary Assn.
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