HomeMy WebLinkAboutBuilding Permit Application 101 1
MiLE�1Ili1/IENTAL C®NSTR4U�TION L1EN LAUI! INFfJRMP►TI®-N;
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 thepermit 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.
? _
Signature of Owner/Lessee/Contractor as Agent fors,;,--` Signature of Contractor/License Holder "
STATE OF FLORIDA m-�
.. �m� STATE OF FLORIDA � �o 0
COUNTY OF ILVCtr ��o COUNTY OF m�
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The f rgoing instr ent was acknowledged before m z The forgoing ins ent was acknowledged befo sng.�
this�j day of 20�by =r his / day of 'Q 20// by
iss )IC 'A- �N SS c r,1 .
(Name of person acknowledging) ame of person acknowledging)
(Signature of NotVy Public-State of Florida_) (Signature of Notary lic-:State of Florida)
Personally Known OR Produced Identification/ Personally KNUON OR Produced Identification
Type of Ide A�atio Type of Identific5�,
Produced \ (_ ProducedairC
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
All APPLICABLE`INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /Y _ -
Date: G �ty Permit Number: v*MC& L&I
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K EVE'
Building Permit Application
Planning and Development Services JUN 2,0 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Permitting Department
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re ide%iAud"ounty, FL
PERMIT APPLICATION FOR: .� (9
PROPOSED 1�R,!N, /EMENT ��ATION:
Address: 7S'O .5F_ Ild,�lwPti kver Or-
Legal Description: &AA-c --f e Sieria Z6 -) do el%e�j
Property Tax ID#: 3L/1-7 - 70 1-- 0656- eico - q Lot No. Zf
Site Plan Name: Block No. .3
Project Name:
Setbacks Front L/ Back: Right Side: -Left Side:
DM:TAILEION O.F WORK:
plgCP C-%a, g5e Jrc,f- ..
CONSTRUCTIN,'F I—
Additional work to be performed under this permit-c ec a -tat appy:
_Mechanical _Ges'Tank Gas Piping _Shutters _Windows/Doors-
_Electric _Plumbing _Sprinklers _Generator Roof. Pitch
Total Sq:Ft of Construction: Sq. Ft. of First.,Floor....
Cost of Construction:$ 0 0 . Utilities: _Sewer _'Septic Building Height:
OWNER/LE-�SS,EE C®NTRA O'R: .
Name K-11/r2l-I 6Ael w -� /lea✓srsj �-f�J- Name: 7se<ie x5or,'c1
Address: '7Tj gj&JdA1 R,'VeryT Company:_ A--T ck Cn,,,ra5,,
City: 51 tgulz &,.im State:_ Address: 4(er6c/- y&-i-N ei Slue)
Zip Code: Fax: City: OSL State:-,,t-/-
Phone
tate:_Phone No. 7 2 f TZ 9 a Zip Code: 34elf Fax:
E-Mail: Phone No ??2,-9z9-gcIg
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Z -.a,-S!::::
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.