HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —� �— Permit Number:
LIMNLO-1-115 FnJAN
IVED
Building Permit Applicati6 2018
Planning and Development Services
Building and Code Regulation Division nty, ermitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential NJ
PERMIT APPLICATION FOR:
Address: S S M K i a
r
Legal Description: 12- S 3� SE '1Z4 DjP S E �/ N
OF C 1 LOSS 9)F-T 0
G ) �5 - A I\M LeSS t- q1_0 T-T-Fi7 F, 0--) �, v✓ 4Alt> L-ess My9 F Fe c
1 Hc. or - to S O O .2 — (ADO
Property Tax ID#: �� - O a- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRI ,, F
'C)MPLE'tF- NE vj 112;--- OF REI-Ai> E LED H Wtz- `N`512E AND (Ou'T
NM W& EL �/-TP,104- -F-C> 260 AMP API) ON�r-"ikyl --
�=Rot^ 0\;I tKHF.AD Tb UN D•E ?-&K0U u D F-Lr-�TMU'- , 5F-�!cF-
itiona work to be pertormed under this permit-check all that appy:
echanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 5 � Utilities: —Sewer _Septic Building Height:
NE.
R,LESS E' 4 ON ALTO ;
NameA-j'r, 011t Name: S
Address g / S �Mkitls Company: etty-
City: ��1QIgLL State: Vii. Address: 70 KEMWIXD Ro,V
Zip Code: 399Y1 Fax: City: 1T pig State: rL
Phone No._ Zip Code: -5 51 Fax:
E-Mail: ,Mol'(0/4 Phone No (7721 579- 2669
Fill in fee simple Title Holder on next page ( if different E-Mail 5AV5DAD )"--M e-YAH6Ds C.4rl
from the Owner listed above) State or County License E.0 1300695
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable ; JRTGAGE 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
commeDggg work or recording our Notice of Commencement.
L_�� �_ - al�'011*4&w6v
Sig ature of O ner/Lesiee#Cgent Signature of t act /License Holder
STATE OF FLORIqA STATE OF FLORIDA
COUNTY OF T ll� COUNTY OF 5 af. Ly
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledgel before me
this day of 204yby this\e4 day of-Ua►'-\ 201 by
-4&'/ I'S V V,6 ice" �
(Name of person acknow i ) (Name of person acknowledging)
(Signat a of Not y ubli -State nda ) (Signature of Nota Public-State of Florida)
Personally Known OR Produced Identification Personally Known �F produced Identification
Type of Identificatio s.ar Type of Identification ANNA MARIE GIVEN
Produced �� `- k
Produced , &I OSSA J. SFIGER ' ISSION#GG02�
fJotary FubHc-State of Florida °' EXPIRES.December ;A
Commission No, ° '
Commission Na ornr SelkIkes Feb 11,2019 N?
v: Commission# FF 173230
n .... Eo.,drd through Naf .1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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