HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: r�
li.
r
RECEIVED
Building Permit Application SEP 19 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lu ci ounty
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: C Y r
Legal Description:
Property Tax ID#: / 7 3 2- — 7 0 7 - 00 1 � -- 00 o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_�Right Side: Left Side:
AtLED'DESCRIFRON 0111/ 3R
x.00 fps d%1 cown-e� "
itiona 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:$ }� ,Z Utilities: _Sewer —Septic Building Height:
Name uq ,; Name: J .
Address:. 7(� (��� 1n y �}V >� Company:` 1 Z
City: F r�,r 4?-.t P State:fL.• Address: !�c r- cx •X vt IN
Zip Code: L1 50 Fax: City: "V, 2 Stater
Phone No. R b '2 Zip Code: (td I- Fax:
E-Mail: Phone No 2
I Fill in fee simple Title Holder on next page ( if different E-Mail p
from the Owner listed above) State or County License 1%C f 3c�GG`�[ •�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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/L - ----itr r as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO IDA STATE OF FLORIDA
.1
COUNTY OF LSC i� COUNTY OF S/ l�tl',t1L
The forgoing instr.ment was acknowledged before me The forgoing instrument was acknowledged before me
this
=day of ?T2s' 20V�, by this 1ilday of �2b1r2�•.- 20� by
IV
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification V/ Personally Known 6"1' OR Produced Identification
Type of Identific ion Type of Identification
Produced F—� Li ' Produced
Cassandra Meler}dez �
(Signature of Notary P� •tate of Fl&gbdf Florida (Signature of Notary 3!11
J 1 S01uNTILus
My Commission 04/21/2022
aP.
Commission N n11S6KKrn0.GG 201694 Commission No. * 1nC0YNVlC �
�,_ EXrIRE3.
''•'p:r'F�•�' �pnde�Thru NOWY Pablo Undw~
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.