HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �113zo /� Permit Number:--r-I - 0 2A
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APR 13 2017
-- Building Permit Application
PER,-fiITTIi'\11G
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: t �
PRQP®SED INF 01/EMEI�T LL�CATION:
Address: tJ C) 0 S o u 1-14 1 IN iD 1 A N l2 I v ►z,iZ 1202. FT IP1 j>Z Gii ELI) RMOZ
Legal Description:
Property Tax ID#: ?J�{ c7 j 6 C) - O a O -- Z t5 o C Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: X Right Side: k Left Side:
11DENAM,'REDIUMOT0QF AS
S U PIi210R
CONSTRUCT ON'LNF NWIQN:
Additional work to be performed under this permit-Check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construct YZ4
I ! a Sq. Ft.of First Floor:
Cost of Construction: $ " 8 0 bo Utilities: . Sewer _Septic Building Height:
0W =RI E S E: CONT RACTO'R:
Name Rohr 6?� ' �:-& ssny Name: JV3 A/it
Address: 5o,=, s S a,,l 1J i iyo i p n✓ l'Uitn 12/) Company:
City: ;-s Yom, 1�i i� 'cL State:k,o Address:
Zip Code: 0q 9r 9F_ Fax: City: State:
Phone No. _22? #6 (5 l 0 K n Zip Code: Fax:
E-Mail: /VA Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
SLIPPLEMBNTAL CONSTRt1CTiON LIEN LAW I,. FORMA`f10N.
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 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.
Signature of Ow r/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAL I STATE OF FLORIDA
COUNTY OF . ` 11c iE COUNTY OF
The for oing instr ent acknowledged before me The forgoing instrument was acknowledged before me
this day of w 20� by this day of ,20_ by
S
(Name of person acknowledging) (Name of person acknowledging)
1
(Signature of Notary Public-State o Florida) / (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificat'on Type of Identification
Produced NN KAREN S.
c tav np0 ice`
Commission # FF 115637
Commission No. r = f my Commissi),CQl��sio No. (Seal)
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 712-014