HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSTBECOMPLETED FOR APPLICATION TO BE ACCEPTED d
- Date: -71
1 C) rU Permit Number:
RECEIVED
Building Permit Applica ion JUL 13 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County P rtr�itting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462=1578 Commercial Residential
PERMIT APPLICATION FOR: 1 r NC g
PRQROSED INPROUEMENT LOCATIC3N:
• J
Address: �� 1 � P
Legal Description: �3 y-�-} 4E5± 7_5�:a C�
Property Tax ID#: `t'� j ��}' `� G e--c-) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRl�PTtON QF WOR'K
CONSTR I AMt0IRS ,N'II. ATI s r
Additional work to be performed under this permit-check 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:
OWNER/Alf SEE CONTR Q
.Name k CA Name:k;�' }�;`rl��Y ���1(W
Address: Company:.O of `�GiC%G�a CI P Company . _-
Cityr_ � ,_ �C 'P: State: -C. Address
Zip Code:'54 l _ Fax: City: Stairte
Phone No. Zip Code: Fax:
E-Mail: -3 k C Phone No
Fill in fee simple Title Holder on next page if different E-Mail
from the Owner listed above) State or County License1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 't��lay
SU ° PLEION I' N LAW I� 'TORMATIC
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.
Signatui4 of Owner/Lessee/Cont actor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF Jt LU 'LtP. COUNTY OF
The forgoing instrunt was acknowledged before me The forg�gqing instrum nt was acknowledged before me
this� ay of V V 20� by this 121lay of V 20-0by
��i 7r�`cl P ✓ Zl�P�1� 80 Md.S �_Oy
(Name 5orf
son acknowledging) (Name of pers n acknowledging)
L
(Signat Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known \// OR Produced Identification Personally Known OR Produced Identification
Type of Identification y Teresa PdempnL"Mo Type of Identification If Teresa Peterson Lem$
Produced NOTARYPU@Llg Produced PUgUC
_STATE OF RlpA ARYSTATE OFF LOW
Commission No. C jFP24 Commission No. �d
Expires 6=2 -10 1g1� F
1
Expires 6/22/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014