HomeMy WebLinkAboutBuilding Permit Application JAN-12-2018 FRI 09:00 AM CENTRAL SCHEDULING FAX No. 3212686138 P• 002/004
ALL APIPLI ABLE NF �I IUST F3E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 I Permit Nu 5
REC
V.I n�IW IT 'wtityk
JAN 12 2018
Building Permit Appli ation
Planning and Development Services
ST.Lucie County, Permitting
Building and Code Regulation Division
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
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Address.
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Legal Description G 1
Property Tax Ib#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:. Right Side: Left Side:
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Additional worK to Ue ertormed un er t :s per ck all appy:
UHVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: 5 Ft.of First Floor:
Cost of Construction:$ 5 Utilities:`n Sewer Septic Building Height:
Nam 1 Name: ilJ7,M(Y}3
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Address: i Company:
City: State: Addr
Zip Code: Fax: City:' '� State:
Phone No. — — Zip Code:
Fax
E-Mail: Phone o a
Fill in fee simple Title Holder on next page(if different E-Mail: 1
from the Owner listed above) State or County Lic se:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
JAN-12-2018 FRI 09:00 AM 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 clothe 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.
Slgnat e f Owner/Lessee/Contractor as Agent for Owner Signature f ntractor/License Holder
STATE F FLORIDA3 j I��, STATE OF FLORIDAN ��P�
COUNTY OF ( _,4 COUNTY OF {
The f going Ins enc was nowledgbefore me The forgoing instrul ZLpnt was ac nowledg before me
this day of 20 by thiiday of Q 20Tby
`�. lt-
Name of pe n making statement Name of person making statement
Personally Known 7m OR Produced Identification Personally Known_ L. OR Produced Identification
Type of Identification Type of identification
Produced Produced
(Signature of Notary Public- L�LR1eTIAB frr (Signature of Notary Public-State orida)
n8 Catherine Konger
�7 =C a#FF172372 Commission No. lon#IFF172372
Commission N �Z r� C
res:OCT 28,2018 .• .`F,xpires:OCT 28,x018
15rAL0 U THRRY LLC +� O�N;,`" HONDED THRU
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev,8/2/17