HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `4 _ _
Date: L( � •
./ l Permit Number: Iv� ��
LI I ' RECEtVEp
miiiiiiiim Building Permit Application MAY 04:.2018
Planning and Development Services Permitting Oe
Building and Code Regulation Division St• Lucie patent
2300 Virginia Avenue, Fort Pierce FL 34982 County
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: '10 "A 6Of44-1I & 4r4 Qd 4 Lui p . c1 Scict 2 5
Legal Description: .
Property Tax ID#: 3 ( ( 9 ' 5 LID ' 02 4-' 000 ` i Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front _ Back: , gi• ` Right Side: 1 1/2 Left Side: d ,
DETAILE � ,ESCRII TI®N=C}�I= W RKY a' �,rlit _ /'
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Additional work to be performed under this permit—check all that apply:
• _Mechanical _Gas Tank _Gas Piping .. _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers : _Generator _Roof Pitch
Total Sq. Ft of Construction:g,�-4 ei3 D <9,-(2- "Sq. Ft. of First Floor: .
Cost of Construction: $ \Cp 00.' c d.• Utilities: _Sewer _Septic Building Height: _
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OUti 'Et /LCtttt inn l•i CONTRACTORS. ,ft_i � �
Name (,�4ecc- a -- C \IOA C ' Name:
Address: \\C) a� �} -4 Com an : �'b-L� t'lL
J4� ' p y Y"c v
City: .1. S- L. , State:c Address:
Zip Code: QFax: City: State:
��
Phone No. n) C,r4�` ,S :R5 Zip Code: Fax:
E-Mail: s_ + - c. _ a c,'Phone No _ _
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DO POW EEI `L,CONSTION . N E RMAT[ LV:1 $ ,' f.
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^ . 41.'• 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
commenc' g work or recording our Notice of Commencement.
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.
E. Signa ure of owner/Lessee/Contract s Agent ft., :=• " Signature of Contractor/License Holder
":.e'S •` STATE OF FLORIDA
STAT. OFF �RI r ,�;1=�- <: .
COON' Y O' f ba*e` COUNTY OF
The forgoing instrument was acknowledg d before -?,,,1-.x�� The forgoing instrument was acknowledged before me
oI�j
this day of ,20 l8" by a- o0°9 this day of , 20 by
r-
; a frri ',a
mi Alia Man t U 'Ds : 3
(Name of person acknowledging) 18p .;Name of person acknowledging)
W tI'N
Ait
,ear,./ - a '
(Signature of tary Public-State of Flo 'da) / (Signature of Notary Public-State of Florida )
Personally KnoOR Produced Identification Personally.Known OR Produced Identification
Type of Identification Type of Identification
Produced d . O' 604 t . Produced •
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW , REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rec. 7/2014 .