HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a.3 Permit Number:
RECEIVE®
Building Permit Applica ion JUL 2 2018
Planning and Development ServicesST. Lucie Count Permitiiil:
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: v
PRt�PO ED IN�PROVEMENT OCATIQ-N:
Address:
Legal Description:
PropertyTax ID#: ���� .6 CJ� /� ��� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AILED DECRI'PTION OF WORK.o 41
1 c° G/� nJ6rc o V -- S A (�f Z=2r, 726E- 1V16
R4i1414 — 3 729XIS
CONS U TI N NFORMATIO'N:
Add
itiona workto a pe orme un er t is permit-check a that apply:
gmechanical _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:
OW ER LE�S �E: CONTRA OR:
Name fi4Yd/A a R Nx1 9 66ERN10/U;4 Name:
Address: 602 09 61,C) 6W46=77- Z VA Company: 6 C4,Arltl l C1 b .b7T/bl/ :06"
City: F04-r Stater Address: '%LZ SLI �ULlrP• /3L tl , c�
Zip Code: .3�9�a 2 Fax: City: iDD,eT. S�1h7T� L U C% . StaterL
Phone No. .3/O �,6( _/ � Zip Code: Fax:
E-Mail: Phone No74•
Fill in fee simple Title Holder on next page(if different E-Mail �b�< r✓��Y'�4�I�/T/bA/J/ftp(,%%i6�Oj-!Lt
from the Owner listed above) State or County License���
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU=PPLEMENTAL CON-T TION LIEN LAWF. FORMATION:
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
commenci work or recorong your Notice of Commencement.
Sigfnature of Ow er/Les ee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S ', Lyc'�� COUNTY OF
The forgoing instrument was acknowledge4 before me The forgoing instrument was acknowledged before me
this today of$y\'i 20\ by this lk� day of-_311�`f 20 R by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L Produced V-L 0 L
(Signature of Note Ptttjl i .State 6'€�NW ' ' C;' , I� Si nature of No td GlvErts
1_ i, `• futY COMPdISSI #GG 0_20,73 �' ( g ryp tc-StatefrRtbrliY�!
2020 ,�i - ...
r?CPIRES:D cembar 15, ;=S' °= MY C05flt�11S510N GG 022023 �'.1
Commission No. = 0 J, ic9JnderxritOM ��J � FXPIRE5:De r��1 2020 ilJ
�dThrutyo , COmmisslOn NO. �� �a!}:denudtery
" ''%:°;; •' V' • ..•o: onaed
Thr Notary
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17