HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 176�Date: � � Permit Number: RECEIVED
� �s
arls� u
Building Permit Application SEP 2 6 217
Planning and Development Services PEWITTING
Building and Code Regulation Division St. Lucie County FL
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 Feree.
Address: 50 6 0eleDO \/
Legal Description:
Property Tax ID#: 3C1 1 " �o[ OU S�' �C%�'" Lot No. 1
Site Plan Name: Block No. 41D-5
Project Name:
' Setbacks Front Back: Right Side: Left Side:
V i R <.3 - ..
may /� (] kxr "z ,g rsC''x' -�.g,.- 3
Iw«3sE:il�a!$.7" � � 9 AO-IF ' P Rl
s sP a � �
„
Cl
s
m MAIM IBM!
W p e"
HT � �t
1 0
itiona wor to e e Orme under this permit—checK all appy:
HVAC 0 Gas Tank E]Gas Piping _Shutters Q Windows/Doors
11 Electric ❑Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 17 S . Ft.of First Floor:
Cost of Construction:$ '2-,L460 -_
.,L4 6 0 Utilities: _Sewer E]Septic Building Height:
a �-
{'
Name in M CILftrUJA Name: 2•p1
Address: &' &G ;P-- Company:11a.,6 -e. Nx&,3 Umshq_ar4i
P
City: �iP_2� State: Address: __JJ' A SuO ESCI-,
Zip Coder j Fax: City: P-^dry\ (�a-ca State: Fl—
Phone No. �'Z= g�tZ-(J la 4(o Zip Code: Fax:
E-Mail: Phone No. �l�L� 7rz-0- f*S5
Fill in fee simple Title Holder on next page(if different E-Mail:��v\r/La ��dLs'l i�y1 Q W Cz1`^n
from the Owner listed above) State or County License: C&C 015-7 .35
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
c'? � "l��' .: ��1s�J ����.L`i.. 'i--:ti'.lt a�' ':. 'I,�I•, 'StY #3 T'��� ` �� ;�'v,.. _ •.: .+'-_• ,.Y _� �,. � i ...• '.
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
cornmqncing work or recording our Notice of Commencement.
- k"4dj4= hh,'J b L-1��4-
Signature of Owner/Lessee/Contra for as Agent for Owner Signature of Contractor/License H der
STATE OF FLORID STATE OF FLORIDA/�`�
COUNTY OF _ _ COUNTY OF _.fC.1�l
The f9going instru ent was acknowledged before me The for oing instrument as'acknowledgedefore me
this day of 20)J by It day of 20�7by
Name of �
person ma g statement Name of person ing statement
Personally Known,ORProduced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
a c
(Signature of otar $�" ta orf g61 a i (Signature of Notary,p -State of 51WOCL�1)M HUFF
y tate of Florida ,� e'er
k a = Commiss' FF 234730 Notary Public-State of Florida
Commission No. ;*.l� ,�, e l) ff Commission No. i= a ! , •= Commissio�6eA)234730
omm.E•pares May 27,2015, .
== y?; My Comm.Expires May 27,2015
^d:rl through fdational Notary Ass.n. or v
'�����«�O BandedihroughNationalNoiaryAsss.�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17