HomeMy WebLinkAboutBuilding Permit Application ADatLLAPP CIBLEINFO MUST BE COMPLE'rED FOR APPLICATION TO BE ACCEPTED
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Permit Number
RECEIVED
Building Permit Application
SEP 14 2W
Planning and Development services
Building and Code Regulation Division PERMMING
C ty, FL
2300 Virginia Avenue,Fort Pierce FL 34922 St* Luc
Phone,(772)462-1553 Fax,,(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR' To Select from dropbox, click arrow at the' end of 11ne--,,,
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Address:
Legal Description-,
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Property Tax ID#:e1AW-D-n- fzf5-2-6-2— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side. Left Side:
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VAC 0Ga`s"P'iping Shutters �Wlndows/Doors
. 11 Gas Tank H
■Electric ■ Plumbing —1prinklers
r CGenerator F]Roof Roof pftc;h
Total Sq.�t of Construction, Sq.Ft.of First Floo• r:
Cost of Construction,.$ Utilities: ■Sewer OSeptic Building Height:
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SEP-14-2017 THU 12;46 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 003/004
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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 Horne 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-residentlal 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 inspectlon. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording yotir Notice of Commencement.
Signature`6f6w or/Lessee/contractor as Agent for Owner Signature df C ntractor/License Holder
STATE OF FLORIDA FLORIDASTATE OF
COUNTY OF � • COUNTY OF )j • � , cJ,V e
The r oing ins t a was acknowled a before me The for oing instr mens:was acknowledged before me
this P day of ZO�,by this day of 26 Uby
(e-- c e�
Name of pers n making statement Name of person making statement
Personalty Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced_ ... Produced
K2�
of Nota Public-State p' lori
(Signature of Notary Public-5t [ori Aerkg Konger (Signature rY W F" )therine Mnger
,• C DRWFP172372 f�q,
Commission N _. ' • Commission No. +�C [on#FF172372
y,- "•.• TOCr xau Q�g S•, :';Expires:OCT 28,201a
1SPFLOMDANOTARXLLC iSrPLOR DANOED TAA�,'LLC
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2J17