HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0 O�4,�_
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Building Permit Application SAN - 3 2018
Planning and Development Services Permitting Department
Building and Code Regulation Division St.t_ucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: .
.c`" sa c. S,s � C* a
Address: Ire_ f'T l
Legal Description: i1\"�' � d Axti ks S'A� fPZ
Property Tax ID#: `I v - ��S"'��� -1���-� Lot No.
Site Plan Name: Block No.
Project Name: 0
Setbacks Front Back: Right Side: Left Side:
ear � a S c� e ;160 `:; e�j
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Additional work tobe e pe orme under this permit-c ee. -a t at:app y:
Mechanical _Gas Tank _Gas Piping:' Shutters _Windows/Doors
Electric _Plumbing _Sprinklers'' ,, ._:'' `=Generator _Roof Pitch
Total Sq.'Ft of Construction: /,� Sq. Ft.of First Floor:
Cost of Construction:$ /aQC> Utilities: —Sewer _Septic Building Height:
, 5 �.s .,� "`.^ s
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Name C �g WA 6+4- Name: VAN04r 11
Address: 9N _y- Company: 3\) V
City: Vbrl- -VN\--[Lr F t- State: L- Address: r�, �z9A-e_ G b-e_�
Zip Code: _Q Fax: City: i� ' -� State:FL
Phone No. oZ• 0 Zip Code: 3P Q Fax: 27Z q67
E-Mail: Phone No 7z 6 "'5_0
Fill in fee simple Title Holder on next page(if different E-Mail 001D wc9-I(er: -e �
from the Owner listed above) State or County License (Lc—
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNE E GINEER: _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.
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Signature of Owner/Lessee/Co tractor as Agent for O er,,, ignature.o Contractor/Licens Holder
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STATE OF FLORIDA pi
=LL& TATE OF FLORID je _-
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COUNTY OF S I �U C' _�a OUNTY OF Lv�'The forgoing instrument was acknowledgecbefore me W he forgoing instrument was acknowledged this day of�(HYturry 20 by his day of fah Ur4o"� ,20 Wr✓ D'D Ep) ,� X11Name of person making statement. ame of person making statement.
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Personally Known OR Produced Identification "' f' ersonally Known OR Produced IdeType of Identification ype of Identification
Produced Produced
(Signature 61
otary Public-State of Florida) (Signature of 616tary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Re—v—.