HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �<bol-04^7 16
m RECEIVED
NP's` AUG 17 2018
Building Permit Application
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: 'A v C
PROF'OEI lf:N 1PROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: 3 JJ 01-S75" Z�? OW Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET I�I.ED D xSCRIPTIQN OF 1AlOR
t✓� ?7 1 G S , t� PY SL .
�C+)' TRt1CTl0 Nf'ORMATION:
Additionalwork to be pertormed 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 IJI-9 1 F171 A,TR OR:
Name, A �2 L-LL . _ Name':- `lZ
Address: L )9 A.AA4AJj � -ST� Company:
City: L State:J^L Address:Jrn/d) CiJ OS 11T),-V UW
Zip Code: �9�Z Fax: City: e,5Z. State:f Z
Phone No. 772-- Zip Code: 3q I Fax:
E-Mail: Phone No �77Z" zo)
Fill in fee simple Title Holder on next page(if different E-MailJ7 tgGll6S�t.�,Al-C,1
from the Owner listed above) State or County License G.'6.1 kl),
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.,
CONSTRUGTI(I ! E LAW I FQ'R ATIQN:
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
Signature of Owner/Le see/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF S�. L%s COUNTYOF S--_
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledge before me
thiO,'A day of d+`l� 20-n by this,a day of f O�20� by
c �% Le- Se,o Lev%
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif c tion Type of Identification
Produced VL 1Q L Produced
(Signature of Notary P xe of Flaf ` F G s
5�•••• M SSION#GG 022023
o YCOMMSSION#GG 022023 �y (Signature of Notary �of
tXPIRES:
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Commission NoVec � dw& publicUndenunle!s; k-� `^' BondeEXPIRd
S:D�er�mbec16,2020 I
Bondedw& NO:�d�C '' BondedTh r�yr))PublicUndenvriter.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE .
COMPLETED
Rev. 8/2/17