HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO-MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J (�
Date: r ( " ,() Permit Number: / 000 T
R PECEOmVED
0 0
JUN 112018
Planning and Development Services
Building and Code Regulation Division
Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial esleni4��le�ou nty, FL
PERMIT APPLICATION FOR: Ar ma n,J(3 -Cn r r
Pdo
PRO00hSED 1IUPR0VEME>14T LOCATION T 7 /per
Address: l r I Y,\ I- I F . Pie r-Q
Legal Description: P0, ✓,� C r'O 9/o_ Sy b t� i !/ }S I O
Property Tax ID#: 3 411 - fid ) (30 35- -Ooo - Lot No.
Site Plan Name: Block No._
Project Name:
Setbacks Front Back: Right Side: Left Side:
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- - --Additional work to be pertormed under this permit—c ec a that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric '?C Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction:$ Utilities: Sewer _Septic Building Height:
0WOWL8_5SEM CONTRACTO11
Name.NameA r rY1 ►\ _ C r-cZ c 4,C Q Name: ( ,e Q k-
Address: 7 (^ �r•1 ✓ o" Company.: QC 2 C rSe P I C) ?-n i nnc
City: Ft ,,Q"q!n State:� Address: 1914
Zip Code: 3qKI ,Fax: City: L State: F L
Phone No. *-7-6%a49Q - g0 Zip Code: 1,), Fax: 40-2- -P�MIS-
E-Mail: Phone No - .5 S
Fill in fee simple Title Bolder on next page(if different E-Mail Pr Q iS e ^ V n� i ,Ca
from the Owner listed above) State or County License C F C
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I DESIGNER/ENGINEER: T Not Applicable MORTGAGE COMPANY: ,Not Applicable
Name: 3 Name:
Address: Address:
I-City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable 1 BONDING COMPANY: TNot Applicable i
Name: Name:
Address: I Address: !
City; i City: I
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,wails,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,jiPMA inspection. If you intend to obtain financing, consult with lender or an attorney before
camne, iW work ecording_ our Notice of Commencement.
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Sig ture of owner/Lessee/Contractor as A&ent-for Owner Signature o Contractor/Lice, older
S
Sig
OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
` The forgoing instru nt was acknowledged before me the forgoing instru not was acknowledged before me
this day of 201 by this day ofj�� 201& by I
j (Name of person acknowledging) (Nam of person acknowledging)
(Signature of Not Public-State of Florid• ? (Signature of Notary Public-State of Florida}
Personally Known ` OR Produced Identification Personally Known- _OR Produced Identification
Type of Identificatitin r i Type of Identification
I Produced �l 4 i Produced TIN WILLIAMS 4
_ f `��p}tY H�
Commission No. (Seal) Commission No. _'?°' Sure o{,For�pa-Notary Puni,.j'
Com ftJh #i GG 1432 4 I
o*C
My Commission Expires #
i
September 17 2021
REVIEWS FRONT ZONING SUPERVISOR PLANS ! VEGETATION SEATURTLE MANGROVE E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW I REVIEW
DATE
I RECEIVED _
i DATE _
I COMPLETED
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