HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `a
Date: a `� Permit Number:
RECEIVED
�■, : AUG 2 2 2018
Building Permit Applic tiOfflie County, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772).462-1553 Fax: (772)462-1578 Commercial Residential
PERMITAPPLICATION FOR:
PRaPOSED 1NPROVEMIENT Lf+)CATI+DN:
Address: 0,4DM-cl(-� &1C 9-043 4 k.i cu e, 3-663
Legal Description: �/�el1( ()✓1i` `-1 'l��/CttC7 lv-+ 1
Property Tax ID#: Syle1 `530 (39!!? , ( 20 C-) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DfTA1LE I DE-CR PTtON OF WORK:
e. Les -t o S6 v e— 23D* Fel U�tc4e�1
CONSTRIJG tON (INii
FO MATO
Additional wor to be pertormed under this permit-check. all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator /Roof l Pitch
Total Sq. Ft of Construction: ciccx�'Qf-1 Sq. Ft. of First Floor: CfiXD
Cost of Construction: $ /-7,61 o Utilities: —Sewer _Septic Building Height:
OWNER/LE�S� EE; CUNTRACTOR:
Name NI�-}i`oli.v /hPti-fo< Aea)4 �✓ (,,,�nn Name: 9600
Address: (EM f )0C+1 ?cV1�tS`Ft✓►C� �cx Company:Shs(k I[ KO�rt,t
City:q*-a n State:f� Address:J�t�3 5>a 6)P,r1G���g 3f'
Zip Code: 333 Fax: City:A--{ Sf ko-e- Stater
Phone No. Zip Code: 3498-) Fax:
E-Mail: Phone No-719 ab0 giY6T'
Fill in fee simple Title Holder on next page(if different E-Mail ,S ( U► C''A Q;lxy)
from the Owner listed above) State or County License cc j33ll-lb
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU' P EME EA! ON,' N 1[7 mumT AW1N9 :
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/Lesse /Gp tractor as Agent for Owner Signature of Contractor/Licn e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTY OF Sic %
Thi�forgoing instrument was acknowledge before me The forgoing instrument was acknowledge before me
thi''� day of �y� 201 by this day of �`J�' 20]I_ by
Name of person making statement. Name of person making s atement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Iden ification
Produced rc V �- Produced
(Signature of Notary Pd
,61iANIpR G022p23 Si nature of No - a e
b tA4SglON#G 6 2020 ( g v of I4 GIVENS
gJ , MY GOM �eMbeta dtars = MY COMMISSION#GG 022023Commission No. �; > orypubtt�u°d Commission No. EXPIRES:Dect1[�6I 2020
"su p: Bopded N .rFo 1„0:•' BondedTtvu Notary P�undenvrtten;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW, REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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