HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFX MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: 1� , 1 Permit Number:
RECEIVED
• APR 0 4 2018 RECEI D
�t�ia , emit pplic do
201
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, PEr inti
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: Yo7? Ppi/S10'q'J$4 CA --T-,
Legal Description:
Property Tax ID#: �33 1' S�3 a 03� dd0 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: 7�1
CONSTRUCTION INFORMATION:
Additional work to be pertormed 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: $ #(� /_ oo - o a Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 5-rm q .512fAx" -41,f{ Name:
Address: 9 Y N CN4A4 00A wT Company: rY,:�) I QC.,a 1 £ (pr_X�C
City: C77171 1'0 Je'ec,� State: -f Address: z;, 3�o f>. /14a /rev 2n,
Zip Code: N Q ) Fax: City: .1 X"-,4;,c1; State:_E_'_C-
Phone No. Zip Code: Fax:
E-Mail: Phone No 72,c,?-.Z 37- a 3 J
Fill in fee simple Title Holder on next page ( if different E-Mail ZNfo a ccs loc.Ak te�Tr��
from the Owner listed above) State or County License��p�a
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LISW 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.
ignature er/Le ontractor as Agent for Owner -11�ntTure of Con actor/License Holder
STATE OF FLORIDA STATE OF FLOR DA
COUNTY OF g k. Ly COUNTY OF -lr. "cy4k
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledge before me
this `� day of o►R 1, 20� by this' day of a Q { -%A 20_a by
(Name of pers n acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida ) (Signature of Notar Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification a of Identification
Produced t— L '!JPr
pEpNNAMAR�EGIVENS 23 .e D GIVENS
Commission No. y ''u` `tc YCpMrAtSS10N#GG02`L ! I yCOM�dISSION GO 023
v :�? *�'e d PIRES:Decen, rl6'20 O i5sion No s' * j�
( `, niers ES:Decem&
publirUnde �'�e publicU^derwriters
BondedThruNotary ;'<�FF oP BordadThruNotary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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