HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _\ �� Permit Number: y$oU 1-o-m
RECEIVED
` APR 0 9 . ''18
Building Permit ApplicaLion Planning and Development Services ucie County, Permitting
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: '�) dd C
PROPOSED IMPROVEMENT LOCATION:
Address: 4e o �'�`?? i�4 A7,//e- t,
Legal Description: e- - ggZ zl Ci l e l.0-- l 2
Property Tax ID#: / L11V-70 Z - 006/7 z060 r7 Lot No.
Site Plan Name: piteous ('0(/'G /4'f Block No. a
Project Name: 1�'A(OgSt
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:��'_ ' Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ". ie, e Name:
Address: Company: i
City: -siWe:— Address:
Zip Code: Fax: City: State.
Phone No. Zip Code: Fax: 272- Y4(- ?Z92
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County Licensees 6os7�6'
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
commencing work or recording our Notice of Commencement.
c/ 01i
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORjn—a`e
COUNTY OF 5k. \_ti1 c%e COUNTY OF
The forgoing instrument was acknowledgel before me The forgoing instru nt was acknowledg d before me
this 0,. day of C V\ 201A by this day of d` C\ 20% by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary blic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification :^. Type of Identific tion
� '�..`" s Produced .,- ... .-a�^••`"
Produced �. � �k�EowEN _ --- - �..
GU,! • Gp7 A2"; DJANNAMh• W:
Commission No. EXP� gemW0ndewrCommi
rt
tdod? i � = ruNotaryPubb!Ar;
BondeG Fo'
(SeF
al)
REVIEWS FRO ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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