HomeMy WebLinkAboutBuilding Permit Application 0 11%_1'- !r—
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 Permit Number:
_ - _,�,�1 RECEIVED
•
Building Permit Applicatio JAN 31 2018
Planning and Development Services Permlttin
ST. Lucie County, _
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:
PROPOSED INPROVEMENT LOCATION:
Address: (/,J /J4 ib �Vn /2
Legal Description:
Property Tax ID#: 3y C 3 331- Q<SC 4 dad "� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
i
��y'"rc� N� /�d'+' �iNJLc� � �'I'YfSL E(p.U�i oc'•4'� �-Q to CL
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check a that ha p y:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
V Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ d d4 U,o J Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 14- Name:
Address: Company:
City: �Q4z-r 19il' c C State: _ Address:_1'0.11r .Qy4tip'4�-+
Zip Code: Fax: City: f3F,et�/ State: �
Phone No. 772- -�f 0 -444_3 Zip Code: 3-_11� (-o Fax:
E-Mail: kVljy. D9,3g (0 �E�. Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail •si"fV_ Cid&-One
from the Owner listed above) State or County License LCG/ 3o a
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 failur co
a Notice of Commencement may result in your paying twice for
improvements to our propert . A Noti a of Commencement must be recorded and posted oqjhtjobsite
before the first ipitpection. If y u inten to obtain financing, consult with lend r an attor ey be fo e
commencin rk or recordin our tice of Commencement.
Si nature of O ner/Lessee/Contractor as Agent for Owner Signature of Co ractor/License Holder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF 6�• Ly c \Q COUNTY OF _s:-V. Lyc
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledge before me
this—J\ day of � 20\1 by this 2L\%day of 20 by
tJev� C -'0r 't
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Nota ublic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IdentificType of Identifioe 1-61'r
Produced l DEANNAMA,RIEGiVENS Produced_ ti-. DEANNAMARIE GIVENS
MY COM N#GG 022023 t ry Ila!NtSSTC>1C!F GG 022023
` = ` XPIRES:De��cT b'e�`16.2020 i y� X 1RES:Der eft r16 0
Commission No. rnruNota �Unuennites I Commission N 0 1
ru WotaryPub r._.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014