HomeMy WebLinkAboutBuilding Permit Application All APPLICA130 INF K LJ5T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z Permit Number: OM L�–6q_l 3
RECEIVED
• - -
Building Permit Application APR 242-018
Planning and Development Services ST. Lucie 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: �v
/'N PROV
Address: / 4!5• e
Legal Description:
Property Tax ID#: 3�\°`– S S—oaya%-0(543 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
'ETAIL�D DESCRIPTION OF WORK: '
4/)or (� d� �ti ��f� n!!2
96 OD 0 ,4 7q
itio a wor to a per orme under this permit–check a 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: $ 0 Utilities: _Sewer _Septic Building Height:
Name oO 4/4 Name: At
Address: 1l(� _ �� e4 Company: VI e_eS e �1n s COO "tq
City: State: Address: goo 7 f!Q4CIrf w�
Zip Code: Fax: City: iGl_ce_ State:IL
Phone No. Zip Code: 3�7i�� Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail�l� �/� �� � / O CO^�
from the Owner listed above) State or County License—d-4-4– /19/83/19/8 39
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFO M TION::
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 roperty. A Notice of Commencement must be recorded a d posted on the jobsite
before the first inspect on. If pu intend to obtain financing, consult with lender r an at , ey before
commencingor r cor n" our Notice of Commencement.
Signature of Owner/L see ontractor as Agent for Owner Signature of Contra ctor/L ens Ider
STATE OF FLO�tIDA STATE OF FLORIDA
COUNTY OF S�1r- L-v c'�a COUNTY OF _ Wc%e
The forgoing instrument was acknowledgebefore me The forgoing instrument was acknowledge before me
thisa�day of 4 Q (�\ 20 � by this a` day of g e �, 20 by
'�,��►�C9�t �n i 0 t S( �� \
-A
(Name
(Name of person acknowledging (Name of person acknowledging)
(Signature of Notary blic-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identificatio Personally Known OR Produced Identification
Type of IdentificationType of Identification
Produced
�NS%s produced \-
?1' �1
GOM"gSSWJ mbaG° ��1e s 'W1 ,
'° J ANNA MARIE GIVENS
;
Commission No. 01f �1CC`e„blcUndeN� Commission No. MvcoMr {{� I #GGo?.2023
pl lyre 1 EXPIRE Dbef 16,2Q20
Nr'rs a:Bonded 11 lo � Bonded Thni Notary Pcblic U"16N i?•;^.: .,
REVIEWS FRO ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 712014