HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUSE BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�,p` Permit Number:
RECEIVED
Building Permit Application
'Ptanning and Development Services J U N 142018
Building and Code Regulation Division
23UOurginiaAvenue,Fort Pierce FL34992 ST. Lucie County, PermittinG
Phone:(772)462-1553 Fax:(772)462-5578 Commercial Residential—
PERMIT APPLICATION FOR: To elect from dropbox, click arrow at the end of Iine
Address: 1,.y
us
Legal Description: ens �,
Property Tax ID#: Lot Nd._
Site Plan Name:
Block No.
Project Name: f� _
Setbacks Front--__-.,._ Bank: _ -- Right Side: Left Side: •-- - —
Kq �t C SIA 61
a vro to rme . Wunert is perms -c ec a Warp-ply.
HVACGaslank Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers O Generator 01:104 Roof pitch
Total Sq.Ft of Construction: So.Ft.of First Floor:
Cost of Construction:$ L/ Utilities: Sewer Septic Building Height:
Name Name:
Address: i (� - `
_ Company f
City:'' [~' State:flu Addre s: . c '
Zip Code: Fax:'` ' City: i State:
Phone No. . Zip Code: r' - Fax 772-
E-mail• Phone No. s
Fill in fe . Imple Title Holder on next page(if different E-Mail: C
from the owner listed above) State or linty License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER ENGINEER: NotApplicable MORTGAGE COMPANY; Not Applicable
Name: Namm
e:
Address: Address:ess:
City: State: City: , State:
;rip: Phone ZIP- Phone;
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ,Not Applicable
Name: Name:
Address., Address:
City. City:
Z71p-. Phone: P:. Phone:
OWNER/CONTRACTOR AFFIDVITI,Application is hereby made to obtain a permit to do the work and installation as indicated,
I certify that no work or installation has commenced prior to the issuance of a permit.,
St.Lucie makes noreprese ation that is gmntinga permit will a4
Torize tie permit holder to build the subject structure
i
which is in conl7lct with any applicable Home Owners Association rules bylaws or and,covenants;that may r rictorprobibitsuch
structure.Please consult with your Home Owners Association and review Your deed for any restrictions vihill" may apply.
In consideration of the granting of this requested permit,I do hereby agree thatI will,in all respects,perform the work
in accordance witty the approved plans,the Florida' Building Code's and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structurest'swimming pools,fences,walls,signs,screen roorn$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 Comniencement 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
orntnencing/work orpocording our Notice of Commencement
Sign 0 er7 Le5see0confractur as Agent fbr Owner Si f Contractor/License Holder
SCT F F R E Of FLOR#
C NTY 0 COUNTY,0F__
-The foryolng Instrument was acknowledge me The forgoing Instr ent was acknowledg%before me
this__Zday of 26,1_1 by this J-3—day of.XU IAe 20J2 by
-7-
Name of person snaking statement Name of person WkInistatement
Personally Known OR Produced identification Personally Kno�vn OR Produced Identification
Type of identification Type of Identification
Produced Produced
CRMG A.6 $MAN CRAIG A.0
a A :1.
MYCOMMIISSION FP9WW2 MY COMMMON
4-1 _A,; Expows May 1 20
EXRRES MW4
(Signature of Notary Public- k atu of Notary Public-State
Commission No. (seal) Commission No. (seal)
Sign
rlrEOffl
ST FLO
C) LOI
N OF
ORI
Pon a I e
REVIEWS FRONT
ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
64—TE
RECEIVED
DATE
COMPLETED
Rev.8/2/17