HomeMy WebLinkAboutBuilding Permit Application From:Bailey Whittemore Fax:(800)757-0066 To: Fax: 1772)462-1578 Page 3 of 5 04i30,2018 1:35 PM
ALL APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: r 30 Permit Number:1 7 O
r
Building Permit Application
Plunning and Development Services
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 To Select from dropbox,dick arrow at the end of line
Address: ,`_
Legal Description: n. P" ' - ` .{_ Q(\i" '
Property Tax I D#: 1s1 GO'y `Q,P 1.5 -CCL:- J Lot
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Site Plan Name: �;'C �.l ��P F K'I'P:-�. s CS LSE;1 Block No. _
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Project Name: 1,..,V* kta -
Setbacks Front Back: Right Side: Left Side.:
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Additional work-to b orme un"er t is
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permit--c ec a appy.
'AC Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric Plumbing ❑Sprinklers FI Generator Roof Roof pitch
Total Sq.Ft of Construction: Ft.of First Floor:
Cost of Construction:$ d 5 C—) Utilities: Sewer septic Building Height:
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Name (l 1. ,. _ Name:
AddrP55: :> Sf` Company:
City: 7 ' '` State:VA Address. `:
Zip Coder Fax: City: = State: _. I
Phone No. i.l_ .CCC.r'— Zip Code: \� t Fax: -
E-Mail: v } �{` i. 'n(rt Phone No.
Fill in fee simple Title Holher on ne age(if different E-Mail:
from the Owner listed above) State or County License:
i
If value of construction is$250D or more,a RECORDED Notice of Commencement is required.
From:Bailey Whittemore Fax:(800)757-0066To: Fax (772)462-1578 Page 4 of 5 04!3(01,2018 1:35 PM
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SUPPLEMENTAL CONSTRUCTION
-------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:_ may, --
Zip: Phone: _ Zip: Phone: 4
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do thework 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 ho6der to build the subject structure
which is in conflict with any applicable Horne Owners Association rules,bylaws or an ants 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,ir.all respects,perform the work
in arrordance with the approved plans,the Florida Building Codes and St.Lucie Coumy Amendments.
The following building permit applications are exempt from undergoing afull 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 thejobslte
before the first inspection.If you intend to obtain financing,consult with lender or an attorney before
tommencin work or recordI our Notice of Commencement.
.. — .
Si ieture of Owner/Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA t
COUNTY OF YV-., �{ `xl COUNTY OF \,� 1 t)6R�L
T he f wpoing in ant was acknowledged before me the f ,going instr cit acknowledged before me U
this
day of��__. 20 by this. day of-���1_\_\ 20�by
Name of n making statement Name of person making statement
Personally Known OR Produced Identification ! Personally Known_X--OR Produced Identification
Type of Identification Type of Identification
Produced Produced
\u. "Q.'
(Signa{url' t Notary Public-State ovlgrida} (Signator IF Notary Public-State of Florida)
Commission P40.C� COkAW9 N#FF1 •' t fi0lLy1NCOLE
1u31 i y ($F Commission No.�IUI 1 c **�0IYIYC01ME&MA*IFF
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
, DATE
RECEIVED
SATECOMP
LETED _ 1-
Rev.8/2/17