HomeMy WebLinkAboutBuilding Permit Application Feb 07 2018 8;41 AM HP Fax page 3
LLAPPLIC L INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
ate: d Permit Number:
RECEIV D
Building Permit Application FEB 0 7 018
fanning on Development Services
uilding and ode Regulation Division 5T. LULIn County, wmittin
300 VirginiaAvenue,Fort Pierce FC 34982
hone: (77 )462-1553 Fax:(772)462-1578 Commercial Residential
ERMIT A PLICATION FOR: To Select from dropbox, click arrow at the end of line
A dress:, T G2 U P/ G
Legal Descrip ion: LA JD g3 rG eSS
Pper"Tax D ti: 33 12 200 ' Q�of 1�• D� Lot No.�_
Si a Plan Na Block No.
P ject Name
S tbacks Font Back: Right Side: Left Side:
i
NMI
2 w d N �— ow /�•ri, S f/5 r,►^a e o"
oo Q !ur'� s'ce r •s`f ons
5� t o6al� U �c s- 'T
itiona w r to a Orme un ert ispermit—c ec a appy:
n i
VAC Gas Tank Gas Piping _Shutters I�Windows/Doors
Electric EiPlumbing Sprinklers Generator Roof Roof pitch
T al Sq. Ft of Construction: S . Ft.of First Floor:
C st of Const ction:$ ,5���� °` Utilities:�5ewer Septic Building Height:
N me ✓" Name: G7t+ S'
A dress: 4.r e, 5 ��! Company: a
Ci y: L s State:_ Address: er It YI
Zi Code: Fax: City: c C e— Stater
P one No. — -- � Zip Code: S 4 S?2 Fax:
E Mail: Phone No. — Gd — 2 LG1S' �—
Fil in fee simple Title Holder on next page(if different E-Mail: at Cr oN G a h io
fr m the owner listed above) State or County License; e- `Q
If lue of cons ruction is$2500 or more,a RECORDED Notice of Commencement is required.
Feb 07 2018 8:41 AM HP Fax
page 4
INS-
alffi-0Own-,`�: •. :an"i' :. fCi-tea
ESIGNER NGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
ame: Name:
ddress: Address:
ity: State: City: State
ip: Phone Zip: Phone: 1
EE SIMPL TITLEHOLDER: Nat Applicable BONDING COMPANY: _Not Appli le
ame: Name:
ddress: Address:
ity: City
p: Phone: Zip: Phone:
O NER/CO JTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I rtify that n work or installation has commenced prior to the issuance of a permit.
St. ucie Count) makes no representation that is granting a permit ill authorize the permit holder to build the subject strtiqure
w ch is In con ct with any applicable Home Owners Association rues,bylaws or and covenants that may restrict or prohibpt such
st ure.Pleasconsult with your Home Owners Association and review your deed for any restrictions which may apply.
In nslderatio of the granting of this requested permit,I do hereby agree that I will,in all respects, perform the work j
In tcordance h the approved plans,the Florida Building Codes and St.Lucie County Amendments.
Th following b ilding permit applications are exempt from undergoing a full concurrency review:room additions,
a ssory stru res,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
W RNING T OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
im rovemen to your property. A Notice of Commencement must be recorded and posted on the jobslte
be ore the fir t inspection. If you intend to obtain financing,consult with lender or an attorney before
ca mencin ork or recordingyour Notice of Commencement.
112
SI nature of O er/Lessee/Contractor as Agent for Owner Signature of Contractor/License Hiolder
S ATE OFF RIDA STATE OF FLORIDA
C UNTY OF �.- y G Z C COUNTY OF S C+ 1 C
e for ping i rument was acknowledged before me The fo ing instrument was acknowledged before me
t s Mday Fsb f u IOA by this day of �/'vati f 20 by
C[[Z 3er ' �-1e n Y) Is
Name person making statement Name of person making statement
P rsonal1,Kno n _OR Produced Identification Personally Known_ OR Produced Identification _
T e of Identf ation Type of Identification
Pr uced Produce
PATRICIA A. GARYON "" PATRICIA A.GARYON
#N0
Va�N., �N.u� ,Notary public Slate of florida -, t�alary pubLc-Slate of Florida- Co018 = My mmr18( naturII�fffip f'Plb ( 133580 (Signat e' , Pub Q"fL rnded Through National Notary Assn. "" 1''' Bonded Ttuough National Notary Assn.Co missia Gommission No. ( ea
R VIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGR�VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIE
DA E
RE EIVED
D E
C PLETED
Rev. /2/17