HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO MUST BE COMPLETED.F.OR APPLICATION TO BE_ACCEPTED O -
RECEIVED zy
Date: Permit Number:
• 1 ,
_.�Mb"_. SEP 0 5 2018 - RECEIVED
T l.uCle unto P m in
B �"' kation SEP 04 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permlttin
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED"IMPROVE MENT LOCATION: .
Address: AJ 2 'a-5 VDO S 3 V
Legal Description:
Property Tax ID#: - Lot No.
Site,Plan Name: Block No.
Project Name
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION :OF,WORK:
' "� Tam'- !�-Sc=�;r2 SS �� ��-��. �-i�t��-►�s1.�},
;CONSTRUCTION INFORMATION.
Additional work to be nertormed under this permit—check
EHVAC 13 Gas Tank Gas Piping _Shutters ❑Windows/Doors
lElectric E Plumbing HSprinklers Generator Roof. Roof pitch
Total Sq. Ft of Construction: S :Ft.of First'Floor:
c� a -
Cost of Construction:$ J�b Utilities' Sewer EI Septic" Building Height:
OWNER/LESSEE: CONTRACTOR:: ;
Name f✓ 2 ��•� 0,0J7_0 Name: L)AAJ - ®Alf!' w A
- ry
Address: a 2vSD _ �V Company: 6�
City: S State: Address: 3 e- L' 13 2
Zip Code: 3 Fax: City tn. !A-^ State:_F_1 -
Phone No. 1 Zip Code: ( � Fax•
E-Mail: Phone No. 78 9 9.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
-- If value of construction is$2500 or more;a RECORDED Notice of Commencement is required.
,I
=F
SUPPLEMENTAL-CONSTRUCTION LIEN 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:
I�
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.
Signatur of Owner/Lessee/Contractor as Agent for Owner Signature_ f Contractor/License Holder
STATE OF FLORIDA ��. STATE OF FLORIDA
COUNTY OF- V-.-T4 COUNTY OF t-
u-- � •�'�' �� ,
',The f rgoing instrument was acKnowledg fore me The f going instrument was acknowledg ore me I
this l day of \ � 20 by this day of �`P 20� yt
Name of person making statement Name of person making statem
Personally Known OR Produced tion/ Personally Known. jltai ation
Type of Identi n PAZHER�NOZ Type of Identifu,P� F�741tW..
Produced 4A x974144 Produc •:�" �� _
GaMa1lSs�eY tr
.22020 :g '. Y �p1R�sMay 2
p 16d
(Signature; - - tate of Florida) (Signatu otary Public-State of Florida)
rn
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
t� RECEIVED
DATE
COMPLETED
Rev.8/2/17