HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �T ,S• (� Permit Number: 11610 O l
CEIVED --_
Building Permit Application ; JUN 2. 201g
Planning and Development Services ST. Lucie County, Permitting
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:
P0POSED 1[Mi IR,,@UEME T LOCATI�
Address:.: 3 S �n'l
Legal Description:
Property Tax ID#: �-7_5-®! co 9- )/-,g 00.?
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRI�PTtON � WORK.
a. ., .may V a 4
i -
CQ STRUCT(ON INFOR,MA ION:
itiona
worktobepertormed un er this permit-check all that apply:
Mechanical Gas'Tank 'Gas Pip g in Shutters '' Wkdows/0 oors`
W — y — — — Q
f Electric . Plumbing —Sprinklers Generator Roof Pitch,
s : — — —
^TotahSq Ft of Construction: ' � " Sq. Ft.of First Floor: '
-'Cos��of'Construction:$ 'RV�L� �� Utilities: Sewer --Septic Building-Height:
OWNER/LE�S�SEE: *ONT�A '`OR:
., .
Name P
Address: /4'q':.3 , . Company:
?:
City: f t co, State:; _ Address:' > `' ' U
Zip Code: 7 Z Fax '" - ="` ""City "'` "(` `" m5 �A � State:
Phone No. -7 Z 7 V Zip Code: � � Fax:
E-Mail: Phone No
Fill in fee simple I&Holder on next page.( if different E-Mail Q L_� ,L-RS.i R0
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S'l1RSTRIJC"I'IONI I I.AW INFORII/IATION:
DESIGNER/ENGI EE
Not Applicable MORTGAGE COMP Not Applicable
_. .. . Name: Name:
Address: Address:
City: State: City: V State:
Zip: Ne Zip: Ph ,ne
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 anyrestrictions 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
=re the first i eeion. If you intend to obtain financing, consult wit len r o n at rney before
encin k or r cord' our Notice of Commencement.
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Signature of Ow er ssee/Contractor as Agent for Owner Signature of Contractor/License Hold
m o
co
STATE OF FLORIDA STATE OF FLORIDA N
COUNTY OF 5-�-. � COUNTY OF i�- a o o n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before �
this' May of 20 by this day of 20ZY by tn a y W
C, H O
a E E
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(Name of person acknowledging) (Name of person acknowledging)*0_15ta�� 1,
_a0 ALL_
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(Signature of No ryPublic-State o Florida) Sign ure of Notary ublic-State of Florida)
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification'✓
Type of Identification Type of Identification
Produced Lritit'$ W C,fr9�
//�+��([�L 1— 1'�F;' KATHRYN H RPER y . +• '
Commission No.taea� �s E?� )� Notary Public-SiaoCrrrFmMis on No. 6r(n Q�= Ljyq (Seal)
s ,: Commission k GG 1800o6
''•;Fr„r���;;':' My Comm.Expires Yx 27,2020
REVIEWS FRONT ZONING ;SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW. . REVIEW REVIEW
DATE ;
RECEIVED
DATE
COMPLETED
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