HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 `3` �� Permit Number:
00
_ Building Permit ApplicatiR. LRECE
JUL 3 2018Planning and Development Services T1ittlrl [}e at'tllle tBuilding and Code Regulation Division 9 p2300 Virginia Avenue,Fort Pierce FL 34982 • ie Co U ntyr FPhone: (772)462-1553 Fax: (772)462-1578 Commercial Resi
PERMIT APPLICATION FOR:
PR+ PON-, DNPROUEM LOCA I N:
Address: 6[(6 ct6 KS0 rn W ek--/
Legal Description: ( .00,St4 Cc)Ve UrlLoi (Olt 27- DgZ7 l
Property Tax ID#: . W Z-3 - 0 2 - G G L U "0 00--`7 Lot No.
Site Plan Name: fAkto Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCR{IPTION C1F W4R
1 �1U ' G C C ' - ,s I 1 V('A-4 IFc,7 A 10,1 -#- G
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f ce ch
C�NSTR+UCTION IN�FOR� -A 10
itiona i w o r K to 6 a pe rtorFri e cluna e t is permit-c ec -a tat appy:
_Mechanical _Gas 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: $ Utilities: —Sewer —Septic Building Height:
0 N��R/L �t CONTRA QR1.
Name `USe� ISG h�n Name: a< C
Address: c((� !2(_KS6V-\ Company: r t'SaeS— LC C_
City: c'crce State:_ Address: 3C RK I2,✓ _ LJbdd S' Dl'-
Zip
l'Zip Code: 3kCf Lf G Fax: City: F'� • Pt'crre_ Stater
Phone No. ',777- - 9-06 - 7(71 Zip Code: 'SL(CLc-( Fax:
E-Mail: S,6�-,'5 +,r-' _J Gni I .GUS Phone No r7?2-- S ?S Z G
Fill in fee simple Title Holder on next page(if different E-Mail 6nSi-r-rce.,nCC-0)
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTACONSTRl1CTl0 IEN 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 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 befo
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent f OvfnerS Signa ure of Contractor/License Holder =0W
Cd inm
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STATE OF FLORIDA =LL( STATE OF FLORIDA -
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COUNTY OF _ 9 COUNTY OF oX
The forgoing instrum was acknowledged b forew The f rgoing instru e t was acknowled before tnQ.,; �.,
this da of / 20 b "i`� g, �'' q'' "
y �y �X thi day of 2d by = ' r``Y_I
rW v Iii•. �?, tiff
.do•.
(Name of person acknowledging) (Name of person acknowledging)
(Signature ffNotary Public-State of Florida) (Signature of NobN Public-State of Florida
i Personally Known OR Produced Identification Personally OR Produced Identification
Type of Identification Type of Identifica#o Q-
Produced �� , �- Produced r' l
Commission No. (Seal) Commission Nov (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.