HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V ,? Permit Numb
__ ..., APR 2 3 2018
Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Count
2300 Virginia Avenue,Fort Pierce FL 34982 yr FL
Phone: 77 - 2-1 7
Phone: (772)462 1553 Fax (772)4 6 5 8 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PI*Q at` IMPRQIIEM Nfi LOCATION
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Address: 40e S 14J,11rA oy v"✓"// Zw '019"/ 'L "-"" Luce lL -644 48 7
Legal Description: hWu2 ; Lrz S id& A 1-Wq/���60C 117;1-J3 9 ! )
Property Tax ID#: 1I- SI 1- 01)69-D 06 - y Lot No.�_
Site Plan Name: Block No.
Project Name: 177e r'le
Setbacks Front Back: Right Side: Left Side:
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DEl'AILED DE5CRiPTIONOF WORKS rtk x � $ 3
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Additional work to e ertormed under this permit-check a appy:
11HVAC Gas Tank ❑Gas Piping 11 Shutters Q Windows/Doors
11 Electric ❑Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: (/C,600 S Ft.of First Floor:
Cost of Construction:$ /,Si0A9 Utilities:,n Sewer E]Septic Building Height:
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Name 1272`/e~ Name::- ��//� �9►-f%e/d
Address: 60 s- LCJIi/ oo✓" r ZZ Company:
City: ova s.-"� L1sae State:/::-(- Address: 223 GCJilJare/ cS
Zip Code:35<`�87 Fax: City: CC�co67 State:/i
Phone No._ '79 - 1179 2487 Zip Code: c3zj27- Fax:-5Z/• 4?7d397
E-Mail: Phone No. d2-1 6�5e/ LoI,��3 /
Fill in fee simple Title Holder on next page(if different E-Mail: r @
_ from the Owner listed above) State or County License: eCE/-Oz
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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.
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
commencin work or recording otice of Commencement.
A� i
Sign atur f w essee/ ontractor as Agent for Owner Signa re of ontractor/License Holder
STATE OF FLOR STATE OF FLORIQAJ
COUNTY OF—X,-.) / COUNTY OF Yevzv�
The forgo'Log instrum t was acknowledged before me Theforg� g instrument was acknowledged before me
this A&3 y of 49 20/f-by thisZ 'Aay of_z�w 201r1by
/4001_0 &K6ea Ilec-110 ale-4-ekl
Name of person paking statement Name of person making statement
Personally Known A,` `OR Produced Identification Personally Known_�R Produced Identification
Type of Identification Type of Identification
Produced Produced
Viat re of Notary Public- ate of Florida) (Si at re of Notary Publi f F109AMNE SCAPICCHICI::►''°� JANINE SWRCHIO = MY M ISSION#GG0409ii
ion N o ission No. October 23,2020
myCOMMISSION#GG040900 ,,�: q, E
EXPIRES October 23,2020
REVIEWS FRONT ZONING SUPERVISOR PLANS. VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17