HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ �� �Co �� Permit Number:
RECEIVED
Building Permit Applicati n JAN 16 2018
Planning and Development Services
Building and Code Regulation Division 5T. Lucle County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: " J 0.c-
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: \3 X01.- 5p 1- C'5d30 QUO-� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: J
Additional work to be pertormed under this permit-check all that appy:
Xmechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name i�&)i�> Le f1Pj(_ Name: 11)(A)Z 1L Hl JJ
Address: 61V61 Czri!1�, G)/(i-a IU tt" /)l',- Company: C oof op
City: i-f. Aelz6e State: Address: �7�7d, GJw Clwk `7/
Zip Code: Fax: City: PyA4 -7T GUe e E_ State: _�G-
Phone No. 27 7j ' 7 6� /�j��� Zip Code: 27*0 Fax:
E-Mail: eg42 yu0-1 Phone No 7744 -P7/ 575-1
Fill in fee simple Title Holder on next page (if different E-Mail )�2P'271110;6 E +C il-2(-
from the Owner listed above) State or County License�I/ � CRCIF3/ SboG
LIf 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.
essee/Contractor as Agent for Owner Sig atur trac License Holder
STATE OF FLORIQA STATE OF F
COUNTY OF S COUNTY OF Q
The forgoing instrument was acknowled e�before me The forgoing instrent was acknowledge before me
this�day ofZgN\ 20by this % day of JVy'\ 20 1 by
mock '"\ \1 4,1.ar1-' -% m
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notar Public-State of Florida ) (Signature of Nota4v Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced l- fl L - Produced
lN, MARIE GIVENS
Gi isL`�1S VV;j, l �P MYCOMMISS N#G1G.O'^•t23
Commission No. �� GG022n2% Commission No. I �r�M6,201!
N S:D
s MY C Mr 10 16 2020
,
uor ac PIRE Notary Public 11o�e^N;
bl c U;derwrile's'i 'eoF Fro,. Bonded Tlw �
Bur.e
REVIEWS FRO SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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