HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 / Permit Number: o
RECEIVED
0- MAY -9 2017
BUilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Residential
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 18531 Kli- \4 -HOLot,
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Legal Description:, /Y'rQAC-Y-t-,z, r-z)LK 2 Losi Z4
Property Tax ID#:_3215 - Fnl Lot No.
Site Plan Name: At Y'Q 1kCCom Block No.
Project Name: Rubic R(_Sidt_ACP_
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Additional work tobe nerformecl unaer this permit—cneCK all tha apply:
0HVAC 0 Gas Tank [_]Gas Piping []Shutters Windows/Doors
Electric 0 Plumbing oSprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction:$ OO Utilities:0Sewer 0Septic Building Height:
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Name Rov)(11d4YI(Irsna Rub�e- Name: L)DJU(I I OPMCIC
Address: -The- PyoksSionnls
1i f�flN 44OWK Q.E Company:
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City:,
Fir CTcf,,- State: EL Address: -�Fp �E NXfC +ILVU
Zip Code: 3_40J�D —'Fax: city: Sit o, state: FL-
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Phone No. Zip Code:.342q 2 Fax: 77?_Zbb -0'A DI
E-Mail: Phone No. -17?_-Z_No•045q
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Fill in fee simple Title Holder on next page If different E-Mail: Qe�M►iltS L)ros(DQMrA__"-coo)
from the owner listed above) State or County License: 1 c(3(.3
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:
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 thepermit 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 you aying twice for
improvements to your property.A Notice of Commencement must be recorded and p t d on the jobsite
before the first inspection. If you intend to obtain financiuit
. wider ora rney before
c mme in work or recording our Notice of Comme
s
Si ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contract icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Gtr COUNTY OF f" ar-H n
The for oing instrument was acknowledge fore me The forgoing instrument was acknowled ed before me
this�day of / 20 by thisay of 20l-by
ble, 11t lidLaP10C)l t
(N owledging) (Name of person acknowledging)
di&_� tiC.t
Signature of Notary Public-State of Florida) (Signature of tary P70"R
tate of Florida)
Personally Kn Identification Personally Known Produced Identification
Type of Identil icrgoCINCIARn MAdELLn Type of Identification Produced
= My COMM SS
Commission RES Jr Commission No. 4 a�ws • KEL DFI
�naeo,sa Ftrn a'r° `�•; Notary Public-Sta
• s 'emmissien # FF 92
, P�:� My Comm.Expires ORevised 07/15/2014 �• �; Bonded through Nationa
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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