HomeMy WebLinkAboutBuilding Permit Application FEB-01-2018 THU 01 :0 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 002
ALL APPLICA E IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
• , f ,,; ; ,� , RECEIVED--�
- z
Building Permit Application FEB 01 �0!8
Plann/ng and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)452-1553 Fax- (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line v
w+�ii ray.r _ hl y
Address: "\
Legal Description: � u
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
A.0-TuN Asca- G"e_ Yl
AdditionalIN
work oTene orme un er t is p rm c ec a !Shutters
:0
❑HVAGas Tank [AGas Piping _ Q Windows/Doors
ElElectric I__I Plumbing Sprinklers El Generator E]Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction;$_'� J���, PCZ..___ Utilities:11Sewer Septic Building Height:
} 4: wpm •nyN.. .3 '7N r P ,
I MIR
'KV7 .w h
� A i
Name (`j Name: G
Address: �� ���- Company: Nt_Eko slC
City. VC o State:�{ Address: V S
Zip Code: ` Fax: City: (1 � Stater
Phone No111- 411 t�4'— 5-1— 2_ Zip Code: &_o Fax,I
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail. Q l°
from the Owner listed above) State or County L cense: W4_-5`
If value of construction Is$2500 or more,a RECORDED Notice of Commencement Is required.
FEB-01-2018 THU 01 :47 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 003
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
11
commencing work or recording your Notice of Commencement.
Signature of OwI e/Lessee/Contractor as Agent for owner Signature
'
nature of actor/License Holder
l 1
STATE OF FLOd1D< STATE OF FLORIDA
COUNTY OF �_)) , W C1 1c, COUNTY OF
The f rgolng Ins t was acknowledg before me The forgoing instrp mprit was acknowledged before me
this � day ofmg— by this day of-WIP9 20_ by
_e H
Name of pekst
n making statement Name of pets. making statement
t
Personally Known )L OR Produced Identification Personally Known_ OR Produced Identification
Type of Identification Type of Identification
Pro uced Produced
Public (Signature of Notary Public-State FloridaFlorida(Signature oNotary ry c- t F.Ior6t6rine xonger Catherine Konger
'CW
a#1ua#FF172372
Ws.OCT 28,2018 �Expires:=28,2018
Commission N 00"172372 Commission N
RONDSO THRUEONDEDTHRU
IST FLORIDA NOTARY LLC IST FLDRIDA NOTARY LLG
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17