HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (0 Permit Number: I
AM
L W6 RECEIVED
Building Permit Application JUN 0 7 2018
Planning and Development Services
Building and Code Regulation Division ST, Lucie County} PQrMlttltlg
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line�\%
PftOPOSED'IMPROVEM-ENttLOCAfl,ON
Address: -K-310, Becick-\ Me_tAkV+
Legal Description: -it)4- !1 oczA,in
Property Tax ID#: 660 V_ 000— i Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED
- blEs"C'RIPTION OF WORK:' ,
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qoNSTRU I WIN'FORMATION:
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Additional work tobe pertormed under this permit—check all that apply: Windows/Doors
0HVAC E]Gas Tank F]Gas Piping FIShutters F
[7r
Electric 0Plumbing FISprinklers E]Generatoro Roof Roof pitch
Total Sq. Ft of Construction: Scl. Ft.of First Floor:
Cost of Construction:$ Utilities:F]SewerFleptic Building Height:
OWNER/LESSEE
'
CGNTRAcTbk: ,
.
Name— Pr Tliur- A n,Lt-it,L Name: LIE> 'tt
Address:_. .n4 A, C4C Company:
City: t State:
_E1 Address: 14
Zip Fax: City: 4;.tate:_1Y
Phone No.
116 t(r-L - 1173 Zip Code: -?c2(;6Y Fax:
E-Mail: Phone No. � geo"J1 rl 7 7
Fill in fee simple Title Holder on next page(if different E-Mail: 18_11�
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
St1PPLEMENTAL,CONSTRUCTION,
LI N LAW,iNFa
'RM ATIQI ,
s .
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
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 't--k . COUNTY OF S,?r..
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Z 0 h k ,20 it by this I _day of 5,0 AA, .20d by
5 6,!?.l, L-w �
ame of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of identification Type of Identification
Produced Produced
,5a� --
(Signature of Notary ublic-State of Florida ;~" (Signature of Notary P lic-State pf:Fl ii1 �1'J�'�S �s
�` RIE��'J Oho �GG a?a-
Commission No. .�. DrNitoo a�a ku Commission No. COX, ' '�c15.�atets
rypu CGU �� ?; c Boa��Y�llotatypubCcu"de
REVIEWS FR ZONING SUPERVISOR PLANS VEGETA ION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17