HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: 7 —7
p
JILL 9
Building Permit Application PERIF.4117114G
Planning and Development Services St. Lucie Cou11t1l, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential __4z
PERMIT APPLICATION FOR:
Address:
Legal Description: A)eyl'�5 1skh� T116 , Anc9 2r
l2r�eh}'S
Property Tax ID#: ����:' �Q�' a '� Lot No. ;?
Site Plan Name: Block No..
Project Name:
Setbacks Front Back: Right Side: Left Side:
LIM,
peV'\o b' Pc we
v � JIM
-
.,
Additional work to be pertormed un er t is permit–check all tat a.pp y:
Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: (S�� Sq. Ft.of First Floor: l5-0 d
Cost of Construction:$ /7d O Utilities: —Sewer —Septic Building Height:
Name.-- AX&f,)�'C( F. R eA S; . :"` e.� S. Name:
Address: `7 Lrahb,c�r GrEe. wa. _ �� C Company:'
City: 10A a env,r1 State:. L Address:
Zip Code: b)� S"7 1 Fax: City: 540a� Stater
Phone No. Zip Code: 3 q19 �� Fax: 7 33V S E A �
E-Mail: Phone No- 77 2, 3y 47y v
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.
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: 7� 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 Owner/lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 17Ct— COUNTY OF
The forg ing instru ent Has acknowledged before me The for ing instru ent was acknowledged before me
this Tday of 2017 by this 7day of 20/7 by
(Name of person acknowledging) (Name of person acknowledging)
(Signat a of Notary Public-State of Florida 6ignatu&of Notary Public- ate of Florida)
Personally Known r i ' t' Personally Known 7 OR Produced Identification
Type of Identifica n#"P&, Notary.PublicStateof Florida Type of Identificati
Produced : Suzan R Kce pen Produced .r*'.�� Notary Public State of Florida
My Commission FF 921235 • • peen
My Commission FF 921235
Commission No. Expires 09/2312 9 I Commission No. 1? Explres09/231fta1)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW.
DATE
RECEIVED
DATE
'COMPLETED -
ev.