HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED <1
Date: / ' / Permit Number:
R I Elk-L D
_ Building Permit AP Dlicati9pp 12 2018
Planning and Development Services
Building and Code Regulation Division Perf3'7ILLIng O6'pareflt
2300 Virginia Avenue,Fort Pierce FL 34982 . �. � Cle fl y, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commel'Clal
PERMIT APPLICATION FOR:
'ROPOSED lNPR01/EMENT LOCATION:
Address: brockS PU1e 3
Legal Description:_5 \ A oC,
Property Tax ID#: _ u — � --boo Lot No.
Site Plan Name:S r �s 9Z/ 206--hon Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
QETAILED DE�SGRIPTI® 01= W®RK:
CONSTR�t1CT1®N INFORIVi TI®N:
Additional work 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: $ :OUV Utilities: —Sewer _Septic Building Height:
0 NER/LE-�S`�ScE: = C®NTRACT®R
Name 4 W Name-: ( Cbir C S
Address:,. ;Company!- W CA S
City: State:v�`1 Address: rclu\ LK)
Zip Code:? I LIS- Fax: City: \ State:
Phone No-,7"7;k, 3-20 7S^7S' Zip Code: &ILiFax:
E-Mails G O Gl S� v%LBS. C- (Phone No -73 S 7 S
Fill in fee simple 4itle Holder on next page(if different E-Mail
from the Owner listed above) State or County L cense 9C. a S
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
S PP'LEMENI'AL CC?NSTRUCTI£*'!A INE;W lAllU ORFQ'RMATI'QN:
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 ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORISTATE OF FLORIDA
�� �}
COUNTY OF COUNTY OF
The for Din instrum t was acknowledged efore me The for Ding instru nt was ac nowledgecl efore me
this day of ,20ffby this day of .20 by
Name of person makin:ZR
t. Name of person making statement.
Personally al! Known duced Identification Personally Known R Produced Identification
Type of Identification Type of Identification
Prod ced Produced
(Sig ture of Notary P i State of Florida) (Si ature of Notary Pu tate of F i�a.) JEANM SPr'WS
�* ,•••, o 0AY pig" JEAN M.SPA �!� � COMMISSION#FF
Co fission Na. �� ,� IL MY COMMISSION#FF mission No. rP * ZIRES:December3,20 9
EXPIRES:December 3, 01 °�e,E oe�O� BondedThruHud 00urySM
177Fi�g`O BondedThruBadgetft S ekes o e�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17