HomeMy WebLinkAboutBuilding Permit Application FEB-21-2018 TUE 08 53 AM CENTRAL SCHEDULING FAX No. 3212686138 P- 002
ALL APPLI ABLE INFO/�MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:J Z'1 is Permit Number:
Building Permit Application
Planning and Development Services
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: To Select from dropbox, click arrow at the end of line
Address: � Y (. IJ
Legal Description: v
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: left Side: Y
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i lona worko nGasTank
orme under tis perms -c ec a appy:
5HVAC []Gas Piping _Shutters Windows/Doors
Electric Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construct'on: S Ft.of First{Floor:
Cost of Construction:$ �� .l.✓tJ Utilities:]Sewer tom.!Septic Building Height:
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Name Name: e
Add resss_- -13Company:.
City: t' aI [ ACide_ Stater Address: 4,—x15e (•
Zip Code: 2 Fax City: (n 1 Cl[� State.
Phone No.--I-) ' 4��1Z�J Zip Code: Cb Fax-JJ 3- 76c�()
E-Mail: Phone No.,r `,0-1-12.- -3^ DU+a
Fill in fee simple Title Holder on next page(if different E-Mail: f�.1 - CUA r
from the Owner listed above) State or County license:
if value of construction Is$2500 or more,a RECORDED Notice of Commencement is requlred.
FEB-27-2018 TUE 08: 53 AM CENTRAL SCHEDULING FAX No, 3212686138 P• 003
NICE`' �w Jo�ib{.7.
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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.
1 certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting apermit 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 1 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.
Signature of 0 n r/Lessee/Contractor as Agent for Owner Signature C tractor/License Holder
STATE OF FL RIDA ,` STATE OF FLORID
COUNTY OF � COUNTY OF
The oing Inst ent was acknowledg before me The r oing instr t was acknowledg efore me
this day of 20by this� a of 20y
Name of pe on making statement Name of pgr�on making statement
Personally Known OR Produced Identification Personally Known 9! OR Produced Identification
Type of Identification 'type of Identification
Produced Produced
(Signature of Notary Public-St FIor (Signature of Notary Public-State ,Florida)
Fy� 61erine Konger :�'' Catherine Kongelr
Commission N +:Won#FF172372 Commission No" CYC iWoa#FF17237Z
s OCr 28,2018 `Expires:OCr 28,2018
RONDEDTHRU �4 p� 110NDHDTHRU
=FL01UDAN0TMY.LLC +J„u,r` MFI.ORWANOTAR%LLC
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17