HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \-1 1 Permit Number:
RECEIVED
Building Permit Application JAN i 72"018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Shutter
PROPOSED IMPROVEMENT LOCATION:
Address: ib � Dy-. `T
Legal Description: T 100.nck
r h O 4
Property Tax ID#: 4 11 -,561-Oc9c?b —OCOO —^] Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
_i--) `,J'1(..t�1 1'f l�-�iJ� L�J1) �,1\,U�C! III1�-�•S
=CONSTRUCTION INFORMATION:
Additional work to be nerformed under t ispermit—check all appy:
HVAC Gas Tank E]Gas PipingOGenerator
Shutters Windows/Doors
11Electric ❑ Plumbing Sprinklers F] Roof Roof pitch
Total Sq. Ft of Construction: SZ� Z� of First Floor:
'
Cost of Construction:$ Utilities: Ft._Sewer F�Septic Building Height:
OWNER/LESSEE: CONTRACT..
Namekiroldt Ll1110Ar) j.11 , Name:
Address: 107k 6'&j 21 t�^. LT q9 Company:
City:�r�r' Oyl 13&d_'2._ State: FL Address: 7b1 SI.J lfl�Ote' _
Zip Code: 3495 Fax: City: k L- State:L,
Phone No. '7702 • 22!q 701141 Zip Code:a 3 Fax:
E-Mail: Phone No. IY7 —
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: i�A(_7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
commencing work or recording our Notice of Commencement.
r-- c
Signature/k Owner/Less /Contractor as Agent for Owner Signature of C ntractor/Lice e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -> L,,E ,t COUNTY OF _� 7 Gcc Gid
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this �'/ day of :�'l b tII .20'I by this /11y day of �Y G�/ 20 , 7 by
Jetu_mtAh JtYttiiL0.—, -) 2YlA rn, rusc"0 i
Name of person ing statement Name of person king statement
Personally Known_ R Produced Identification Personally Known L.- OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature f Notary Public tater F o i (Signa r of Notary Public-State
Notary Public State d Florida �v r
/ � ane Alberico ;o ` =tjos
ed to
Corr>�nis on No. M fission GG o2o67s om�rli ion No. � ,ealbeIIExpires 08/16!2020 �� * P G 02 8a0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17