HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO )MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ] /�
Date: / �' Permit Number:
I. r
MEM M 69 C-3
a i
Building Permit Application SEP 18 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. LU C d e o LI nty, i IL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Rdsidentid
PERMIT APPLICATION FOR:
PROPOSED lNR_30 �MENT LOl CATIO {N�:
Address: '1`'1(��
Legal Description: �(.�
130 l - to n 3 - ® (9 -3 -- 000 --- '7
Property Tax ID#: Lot No. �
Site Plan Name: i Block No. �3
S,,Project Name: eD
Setbacks Front Back: �' Right Side: Left Side: .
DETAILED DE�SCRIPTION aF WORK;
16'X l0 I ;/Vo
CCONS RUCTIfJ�N I�NFORMATI®N:
Additional work to be pefform—e-d 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:$ 0?4 Utilities: _Sewer _Septic Building Height:
OW ER/LE�S�SE�E CfJNTRACii!
Name p W 'Name:
Address: p CJ Company:
City: (-�- PL ef'CG— State: A CC Address:
Zip Code: 5 Fax: City: State:
Phone No. CDLO -� qQ t – �L ?J Zip Code: Fax:
E-Mail: L e0010 � hone No
Fill in fee simple Title Holder on next page(if differen � E- " ail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPP EMEAL CANS �R{IJCT (�? L.I�EN' UVI� �12R�MAI",C
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/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF X i-e COUNTY OF
The fo5ring instrument was acknowledged before me The forgoing instrument was acknowledged before me
this � day of �
onbpr' ,20� by this day of20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type.of Identification
Produced AFL Icy o-4fS L_i 5Cen<Y_ Produced
A0 A
4( 1g*natuFevoff Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. FF95w. ) (Se t r Stephanie Moure
Q NdTARY ission No. (Seal)
c �STATEO FLORIDA
J
20
REVIEWS FRONT ZONING •�16PERVI 6� "4RANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.