HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Y'1
Date: B Permit Number: / �V (t-9
r Taa s aa�c�v
Q +.i
s r
Building Permit Application
Planning and Development Services MAR 21 '2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential I,/
PERMIT APPLICATION FOR:
11,7
ROBESON INPROUEMENT LOC TION;
Address: M03 Maala, 112me^ /fir. 140 St 4ueiz-
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: nn Block No.
Project Name: UD e r 0 PC re s
Setbacks Front c7 l�,_ Back: Right Side: 7 Left Side:
DETAILED DESCRIPTION � F WORK; /J
t
COISTRUCTIQN INFORMy.ATIO .
Additional work to be performed under this permit–check a -that appy:
_Mechanical _Gas Tank _Gas Piping Shutters Windows/Doors -
_Electric _Plumb in _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� v Utilities: —Sewer _Septic Building Height:
0 ERJLE�SSEE: CONTRA
Name ,G-v,4AJ 1 . 119. e� Name:
Address: ,9 D Company:
l G 3 A�laa�. �.,tv� ,dam.
City:TloRLa. --X& Z4,--i e State: Address:
Zip Code: 9P!7 Fax: City: State:
Phone No. Zip Code: Fax:
T�
E-Mail: GrD Phone No
Fill in feesimple Ti le Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Wl"PLEME NA CONST fU T10N LIEN LAW IN. ORIUI1011
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 thepermit 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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument w s acknowledged before me The forgoing instrument was acknowledged before me
this—'I/ day of Marg 20JL by this day of 20_ by
Lfso rhLCL
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
ersonall Know OR Produced Identification Personally Known OR Produced Identification
Type of Type of Identification
Produc die""�'`'"'+ 1 ISA FZLAGK Produced
MY COMMISSION#FF1 $�9s (Seal)
Commi sits} y 14, 018) Commission No.
(ao7)388-0153 FIoridallo_ryServlce.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014