HomeMy WebLinkAboutBuilding Permit Application 07/16/2018 15:19 772-567-5290 JIM ROTT HOME IMP AC PAGE 02
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SUM=
jREOGIVEU
Building Permit Application JUL 17 2018
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Permitting D e rtm e n t
Phone:(772)462-1553 Fax: (772)462-1578 Commercial esWbntiWci ounty, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
k
Add cess:
Le al Description: �1 _��111d R� r— .) �� G L
� LI G '=04:5
Property Tax ID#:t (`� U r) 1,0 Q � _12(7(2 _ _ Lot No. (.
Site Plan Name: Block No. to
Project Name-
Setbacks Front Back: Right Side: _ ._ _. . Left Side: _.. .
car � �-� i � Sys - 1y) CA
I INS
" e
ciditional work toe e Ormed unde this
,]permit check all appy:
HVAC Gas Tank Gas Piping Shutters ❑Windows/Doors
Electric Plumbing OSprinkiers El Generator O Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ ,$", Utilities: Sewer OSeptic Building Height:
E' '
Name Name:
Address:7 S-M Isg1 alt- ( _ CompaiI
City:."For'j-1 .to i"-.-- e- State: Address: d
Zip Code: _'1!J!J-S" If Fax: City: State:-F—L
Phone No. > - Zip Code: � _� to cvf Fax: X10
E-Mail: di, Phone No. - —
Fill in fee simple Yitle Holder on next page(if different E-Mail: CFo
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
07/16/2018 15:19 772-567-5290 JIM ROTT HOME IMP AC PAGE 03
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DESIGNERIEN611NEER., rtAcabieMORTGAGE COMPANY: �.,Not Applicable
Name: Name:
Address: __ Address:
City: State: City:. _ State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Appiicable BONDING COMPANY: Not Applicable
Name: Name:
1 Address: ___ Address:
City:_ City: Phone:
Zip: Phone: „ Zip:—�
MINER/GONTRACTOR 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 Countx mak�,,no represent tion that,Is¢ranting a rmit wit]authorize the permit holder to build the subjects cture
which is in conWict wlth any appllcab le Home Owhers Association rules,bylaws or an covenants t at may restrict ar ro ]�it such
structure.Please consult with your Home Owners Association and review your deed r any restrictions which may a ply.
in consideration.of the granting of this requested permit,i do hereby agree that I wi1(,in all respects,perform the work
in accordance with the approved plans,the Florida Bullding 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-reaidontial 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 finencinR,consult with iender or an attorney before
commencing work or recording our Notice of Commencement.
Whatuif of Owner/Les
0elContractor as Agent for Owner Signature ntractor/license Holder
STATE Of FLORIDA_ , , ,� STATE Of FL RlQA I
COUNTY OF,,,,, �� (�G i COUNTY OF 1116LIA M P1 V y— ---
The forgoing instrument w ¢acknowledged before me The forgoing instrume t was acknowledges,(before me
this_f_,(qday of 20 by thi$JJX%day of 7nj3( by
(
� �
la ; L
WArne of person making statement Name of pers n making statement
Personally Known OR Produced Identification __ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
on 1,
JSignaturN Nota blit-State of Florida (S re cf Notary Public-State of FloridaFI
)
Commission No. r. FI
MARY EL12A8E No. FU25.2U.-- a pupio d
Commission#FI 958.228 M
- Tres Februa 1 2020o+o
REVIEWS FRONT zo P NS . VEGETATION SEA MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
PATE
COMPLETED
Rev.9/2/17