HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C.\ \4 Permit Number: afro-a5IG
RECEIVED
, _
j I
JUIN 19 "18
Building Permit Application
Planning and Development Services
ST. Lucie County, P&mltting
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: To Select from dropbox, click arrow at the end of line Iz-
PROPOSED IMPROVEMENT LOCATION:
Address: __14 4 &.Wh- T%CaJ C.�(
Legal Description:
Property Tax ID#: ��3 rJ "$ �� c�O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
i
20 9el et Vyr �Pa 'r W-f Cl'UtJ
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit—check all appy:
HVAC GTank Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator 1:1Roof Roof pitch
Total Sq. Ft of Construction: Sq.
S Ft. of First Floor:
Cost of Construction: $ 'fl'JOS. Utilities: []Sewer Building Height:
OWNER/LESSEE: CONTRACTOR:
Name • G re_ fowe_'�—' NamMW. e(�
1
Address: r Com
City: 02(-r C(11r1� IUCD State: Add ^h( tEE
Zip Code: Fax: City: State:Fl.-
Phone No. Zip Code: Fax:
E-Mail: Phone No. >
Fill in fee simple Title Holder on next page ( if different E-Mail: —M
from the Owner listed above) State or County License. T
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
t Commission#GG 180622 * Commission#GG 180622
+raQ Expires January 30,2022 +,} P� Expires January 30,2022
*30F W-115 Baled Thru Budget Novy Servkes Y-t"f�,ot' Bonded Thm Budget Notary Services
UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 rest ricti which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respect , perforrR may
Lvp Ep
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendmen s.
The following building permit applications are exempt from undergoing a full concurrency review: oom adddNn , !!�� QQ
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to an ther non-residei�Y�je
ST. Lu i
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result' qt�v $�
improvements to your property. A Notice of Commencement must be recorded and posted on he jokes}'
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.
A GAA,
ig"natur o wner/ ee/Contractor as Agent for Owner Signature of ontractor/License
STATE OF FLIDA STATE OF FLO A I
COUNTY OF COUNTY OF-�
The fo oing inst umen was acknowledg before me The forgoing instrument was acknowledged before me
this day of 20 by this day of JUUs1 20 by
laQ r X15
Name of p n making statement. Name of person mtemeM.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ideptific n Type of Identification
4Proce 1'l� JQ�I Prod ceur f ii airy Public-State of Florida ) Signature otary Public-State of Florida
27 )
Commission No. o�JIY - (Seal) Commission No. �� 7fZ (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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