HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Co \ , �� Permit Number: `1
IFF-4 3 RECEIVED
JUN 0 4 2018
Building Permit Application
Planning and Development Services I Permitting
ST. Lucie county,
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:
Address: �-3 y c,v 5rC) d- C�
Legal Description: RI-ay"100t 0 N) M T_� � 'S
Property Tax ID#: y 1a�-$� J-'�O�1� OHO Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRI ION 0W
fC �, ti �s n �� �, �• to �I 6U "1S
Additional work to be erformed under this permit-check aH that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric lumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� Utilities: —Sewer —Septic Building Height:
Name ll Name: 1a e_✓4- ,,,-, yz?=-
Address: /L 7 �v' w' n�' /IIJI Company:
City: -/h' til'/ State:_L� Address: /7LS
Zip Code: Fax: City: t2 Stater
Phone No. �7 ?7 f �f Zip Code: ?�` `�`� Fax:
E-Mail — - Phone No -7-7 Z- 3-70
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.
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 Fespects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building per it ap ications are exempt from undergoing a full concurrency rev!9'W' : room additions,
accessory structures, i mi pools,fences,walls,signs,screen rooms and accessory use o ano er n9 '-residential use
WARNING TO ER, our failure to Record a Notice of Commencement m res in ' ur paying twice for
improvemen o ou roperty. A Notice of Commencement must be r ord a posted on the jobsite
before the f' sp ion. If you intend to obtain financing, consult wN le er an attorney before
commenci rk recording our Notice of Commencement.
Signaft f Owner/Lessee/Contractor as Agent for Owner Signat re f ont ctor/License Holder
STVE OF FLORIDA ST OF FLORIDA
COUNTY OF COI ITYOF G+-. Ltsc N-e
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledge before me
this�day of Jyhk 20k by this day of u hA 20 IN by
Kdbcr -�'r "..\i i �'0 p% , r i1g c'r2b
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Nota ublic-State of Florida )
Personally Known OR Produce Personally Known OR Produced Identification
Type of Identification F*w�"s p�NAMARIEGNER Type of Identifica
Produced Lam= Produced DEANNAMARIEGIVENS
y�OMMISSION#GG 02202
2020 +
EXPIRES:December 16. WI[711SS10N#GG 022023
v• N tary Public Undervmle' ;� PIRES:Dere bet 16.2020
Commission No. Bonde Commission No. ThNNotarytars
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R 7/2014
ev.