HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: Permit Number: 1
2
RECEIVED
Building Permit Application JUL 1 1 2018
Planning and Development Services
Building and Code Regulation Division ST, Lucie county, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line , ZAI C t1l
Address: 257X12 6)- e_, X-- l
Legal Description: d�; �GL� P/�ye5
Property Tax ID#: Lot No._73
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�q�N"�1=�,/`rl- �t�_h�r�:� h�r-�'zo�✓�--/ �'h c�, ouJ j� a�c ��N��. c-�Gr�� �
/FJ {--►/7�t' °'S;c�� ��i5tin� C/7alicn Q_ K
CONSTR�U 'III�®�N INFOM�AO ;��a����`�.��. �- _�� ��s`r �c yi5►-t 9 �'� ;., --�.,«
V---
Additional work toe nerformed under this permit—check ha appy:
HVAC0 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing OSprinklers E Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Oki
Cost of Construction:$ Utilities:Sewer E]Septic Building Height:
R11fl f�S "E'h g CONTR__p CTOR
s_ .' <,.•;: �. nSS a2 -s �"#�3�.i. d. — S. riM,
Name6 150 Name: 6C_0
AddressO -�L Or ' Company: I _T;td_i N i V2
City: l _f - �r Ott r- / State: Address: lS _57 �
C S ✓
Zip Code:37 C/&—/ Fax: City: PO)rf— 5r> . - LL C,/ -.e Stater/
Phone No.q.5-11'IV4�f= lv�;l Zip Code:'3 '-� 923 Fax:
E-Mail: Phone No.-272 r3�td/y LJS
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 2�,Q�50
ine of construction is$2500 or more,a RECORDED Notice of Commencement is required.
7�t y:,,'` a, e °'F s .' ��3t 3 '. ;! <t" +. _;.MW
- r-
Sl1PPLEMENTAL CONSTR190 ,00ON LIEN M"W'.N,FORMATI,ON � � �°�� � i
wa
.�.. " �...:.,., '�..r.a^ s,�...,','.}': cmc+;ti.x } k::•i .n:. ..zee Sr ,a`�
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 before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF a COUNTY OF J �ic1G,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this f day of �� �4 ,201 P by this 11 day of 20L&' by
,�-
Name of personming statement Name of person"
ersona king statement
Personally Known ✓ OR Produced Identification Personally Known f- OR Produced Identification
Type of Identification Type of Identification
Produced Produced
C) L4,>'t-
..
(Signature of NGryP
f A fp of Florfdfly J RoBERTS (Signature of a ublic-State of Florida)
V
101,^ Notary Public-State of Florida
Commission No. c' ° 'K l�fft
m(J@4gn+ FF 221708 Commission No. D" f� � s
9 FAy Comm.Expires May 10,2019 �aauue CATHY J ROBERTS
Bended through National Notary Assn.
,. °^ Notary Public-State of Florida
M Comm.E pires May 10,20191'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA TI %,; i�T shkoug i,( ►IiaKV15,.
COUNTER REVIEW REVIEW REVIEW REVIEW � -VIE17
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17