HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED It
Date: 1' • D Permit Number: SC — 7
�s 4 l�yr RECEIVE
Building Permit Applicatio JUL 1 1 2018
Planning and Development Services ST. Lucle county, aermitting
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: .��.otz-
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Address:
Legal Description: 4!e y 5,D CO/1 1(,c,,
Property Tax ID#: 'l l 1 ��/y "' Lot No.
Site Plan Name: Block No. L/
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed unclerthis permit—cneCK all that 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:
Name (�-�F'�' Name:
Address: j �.y �� e P� Company: ��ir✓�v��) OIC Iry/�d i I
City: i'lc�-Vi'(J3 State: Address:�YZ .S SFi•�
Zip Code: 1 20) Fax: City:` " pJ ( - State: '��
Phone No. -�?? ` -'?0 Zip Code: Fax:
Phone No 2 Y70 IIS
Fill in fee simple Title Holder on next page( if different E-Mail �✓'�`� rr ZJi�i ri�J aCV, Co �
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 P,L ME kQ III Imons ttJt� I. N lAl�t =-ORMARN .
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,rimming pools,fences,walls,signs,screen rooms and accessory o another non-residential use
WARNING TO O N :Your failure to Record a Notice of Commencement a result in your paying twice for
improvemeMlw_ y ur property. A Notice of Commencement must be/rec"rded nd,ppsted on the jobsite
before then ection. If you intend to obtain financing, consult 't end or'arl attorney before
commenc , /j or recording our Notice of Commencement.
� r
Signatu'e of Owner/Lessee/Contractor as Agent for Owner Signaturd'V Contractor/License Holder
STATE OF FLO A` STAT/OF FLORID
COUNTY OF COUNTY OF
The forgoing instru e t was acknowledged before me The forgoing instru e t was acknowledged efore me
this day of 20 by this day of 20_b by
in aA4 -RKtgnu)
(Nam of person acknowledging) (Name of person acknowledging)
AA - KA
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-! of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identin Type of Identific tie
' n
Produced L Produced
YP���� KAREN S. NIELSEN ...r.... KAREN S. NIELSE
'_� Ue���State of FIy�id Notary Public ,i° Bc'sS to Florida-Notary P bl
Commission No. - - Commission No. =. *_
ommiss4d�i GG 207484 3y op; ission # GG 207434
"'�off�a , My Commission Expiras o��,F11` My Commission Expires
June 12 2022 June 12, ?_022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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