HomeMy WebLinkAboutBuilding Permit Application FEB-26-2018 09:24 From: 7722172463 To:7724621578 Pa9e:1/4
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ALL.APPLICABLE INFO 1MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number: I Ll 6 75
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RECEIVED
Building Permit Application
Planning and Development Services FEB 2 6 2018
Building and Code Regulatlon Division ST. Lucie Coun ermitting
2300 Virginia Avenue,Fort Pierce FL 349'8Z---:-.--,
Phone:(772)462-1553 Fax: (7 'Z)J462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the and of line �krICAL
Address: 06 0ne f cle f wa • r l r
Legal Description:
Property Tax ID#: I 3 o 1- G GS:— 00 7 Lot No.�
SO Plan Name: IJ t `1 ff,, Block No.
Project Name: R a n e�K K e r
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormedunder this permit—c ecall L=apply:
HVAC Gas Tank []Gas Piping _Shutters []Windows/Doors
2"Electric Plumbing Sprinklers GPrIP,rat❑r C]Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Is-on _ UtilitiestSewer Septic Building Height,:
VIE
Name ,. De ke r` Name: c n
Address: Company: rgoo ` 1all . C e
city:. F-r- P;ere r State: Address:J0 d - 4 _MO d bc,(—o �wY �II r_
Zip Code: 3495/ Fax: City: Ve ro gell-. 5tate:FL.
Phone No. ? 2707 Zip Code: d Iso Fax:
E-Mail: Phone N�j L G
Fill in fee simple Title Molder on next page(if different Elee @ 6ma"I, co r'1_
from the Owner listed above) State or county License: R �3Q( S lr
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
FEB-26-2018 09:24 From: 7722172463 To:7724621578 Page:2/4
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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 prohlbit 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
commenchz work or recording our Notice of Commencement.
Signatur of Owner/Lessee/Contractor m Agen for Owner SI ature of-Con tactor/License Holder
STATE OF FLQRPA STATE OF FLORIDA n
COUNTY OFCOUNTY OF_ �,c(i ri r 1t�i Jam:The forgoing Instrument was acknowledgecl.before me The for��ng instrument was acknowledged before me
this day of �;, /f 20 by this -Z3
day of �r_br�.c�r� 201 by
�T 1L (Gt n�On �'GLi S
4a me of person making statement Name of perso making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced L_ 1. Produced
' R
(Sign ure of Notary Public-State of Florida) (Signatur f Notary Public-State ofMARY�.MILLER
VERNON LEROYKE-NE r �,.�.
Commission No. �� � ahOTARY PUBLIC Commission No,•F._-� �911commission#FF 94
STATE OF FLORID , Expires April 17,202
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17