HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ITS Permit Number:
RECEIVED
Building Permit Applicati n
JUL 30 2018
Planning and Development Services ST. Lucie County, Permitting
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: J
PR�.PUSED IN'' � QVEMENT LQCATIO
Address: Olt t 4 4/%d/),4 Cl Y- �-rf 196.' f � SME 2
Legal-Description:
5
Property Tax ID.#: ,3L1 I C9 503 Ol C4o oo.6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE �IDEMSO�RIPTION F WORK.
C0 �TR�UCTIfJ INFOR ATION:
--ditional worK to be peft—ormed 6nder this permit–c ec a that appy:
_Mechanical Gas'Tank ;Gas Piping _Shutters _Windows/Doors '
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Constructionr:I // Sq.-Ft. of First Floor: r
Cost of Construction: $*
`� 9 769 r Utilities: —Sewer _Septic Building Height:
OWER/LE�SSE :/ f+�C1 TRACTOR:
Name64-4g� c fiG� , I - Narne:'Lv4' AP1 '•YS�e�lo It ' 'r'
Address=5� (�1: '01'1 /i �'o'r- Company.' L:vA�i.• .
City: .��;.. r- � Stater Address NW -- r 2 Z
zi'p.Code:• Y � Fax City:Y�J< S ' %LSC Ih (' Stater
Phone No..'-` Zip Code: 3 4°i r3 Fax:
L
ail: Phone No —772n fee simple Title.Holder on next page(.if different E-Mail
the Owner listed above) State or County Licensee of construction is 2500 or more,.a RECORDED Notice of Commencement is required.
��ML GRNSTR CTION LIEN LAW INFORMATIO
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 thepermit 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 rcoms'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.
S' ature of O ner/LessecTconfractor as Agent for Owner Sign re of Contractor/Lie Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f ping instruent was acknowledged before me The forgoing instru en was acknowledgedkefore me
this day of 20� by this ' day of 20 by
(Name of person acknowledging (Name of person knowledging
��—
(Signature of Notary Public-State of Florida) / (Signature of Notary ublic-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification _
Type of Identific Type of Identification
Produced "'• -4 P EN S. Produced
NIELSEN
"sy
Stat Ie Of 'll Public pYP�e�'
Commission No. =• _Sr Kq E a
Commission No. +, c. M cd��.1 #GG 207464 are Fr(iS� 1' 1E
Y mmission Expires =•� o�c� Com°f iorida_N L`SEN
June 12, 2022 ��''°ilii°� y C iss n G Lary p c
M ° ro # G 911
�r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA JUnB r n �XNG E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014