HomeMy WebLinkAboutBuilding Permit Application All APPLICAB EEIIN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
bate: 1 Permit Number:
RECEIVED
AUG 0 9 2018
- _ Building Permit Application
Planning and Development Services 5T. LUde 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;-L„�'
PROCASED 111NPR%V,E_ ENT I.CJCATII ►N;
Address:
Legal Description:
Property Tax ID#: ��J d 0 4 3-4b0 q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front-`,------ Back: Right Side: Left Side:
DETAILED DEaSRIPTIQN ®F WaRK:
CONSTR(JCTIClN #NFaR{MATIt�N;
�t 1 wor to e pe orme under this permit—c ec a that app y:
_Mechanical _GasTank —Gas Piping _ Shutters =Windows/Do6rs
_Electric _ Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: : Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWN5_R.%SSEE: Q' fi , eRMCONTRAC OR;
Name ` Name.
Address: : '' '/ tA*L1C!!S,&s I Company: := f✓r .�l�J�
City:' l" '6 =� � State - Address:
Zip Code: Fax: City: �� ] � State. 1..�
".7/7 7- X701 =��"�-� Zip Code:�� �`� � Fax: -"
Phone No. s
E-Mail: 1L. + atm;k( 7"
Phone No 'ZZ -70S 451
Fill in fee simple Title Holder on next page(if differentJL Cz�1-04
E-Mail ? j
from the Owner listed above) State-or County License
If-value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
=SNOMENTL CUNSI'RtC1C1"IaN 11 LAW INFORMATION•
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 per 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 m y result in your paying twice for
improvements tq)your pr. perty. A Notice of Commencement must be re"orded and posted on the jobsite
before the first j specti . If y u intend to obtain financing, consult wi lender or an attorney before
commencing w �k or r your Notice of Commencement.
Signature of Owner/Lessee Coritractor gent for Owner natur ntractor/License Holder ,
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF 'S COUNTY OF
The forgoing instrument was acknowledgebefore me The rgoing instrument was acknowledge before me
this day of� 20%4by this day of J 20 •• by
(Name of person acknowled ng) (Name of person acknowledging.)
(Signature of Notary PubIV State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification _ Personally Known OR Produced Identification
t T e of Identificati
Type of Identification IEGIVENs yp
Produced L- p✓�NAMP3� GG 022023
't-Produced aF' D IE GIVENS i
•••• pm(COMMISS10Njnber 18,2020 ' ' MY COMMISSION#GG 0^2„2? ,
ece �i, "~
Commission NO. d '<' �DS.O ry ubllcundecwnlety .�. jp. PIRES:De 6,20
5dP� p ommission No. • � I
•,,�f ;;oec Bone N0� ••,.,.. edTiw Notary Public
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014