HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / ® O�
Date: Permit Nu er•--J - --—- ---
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Building Permit Applicati n SEP 2 4 2018
Planning and Development Services Reri,.i4ttinQ Department
Building and Code Regulation Division St Lucie ®U
2300 Virginia Avenue,Fort Pierce FL 34982Y y FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resl enial -
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED.IMPROVEMENT LOCAT�I�ON:.,
Address: Q 1A NE r (Z `4 S S'.2,
Legal Description:
Property Tax ID#: 3�—J1 6 P)o I 020b 020 f Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AIS- AN6 �c- Z,N L
CONSTRUCTION INFORMATION:
Add itiorA work toe e orme under this permit—check a appy:
VAC Gas Tank Gas Piping _Shutters Windows/Doors
0 Electric 1:1 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ lou Utilities: _Sewer E]Septic Building Height:
OWNER/LESSEE. CONTRACTOR:
Name — kW 1-r Name: 1 A A RA VuL14.P
Address: 90q ( N1 3A, Company: Ic'( 694 A14 IA, <
City: ?-S'L State: Address: C -S3 1J S_ HO LZo,v 4N
Zip Code:�39�,f.� Fax: City: ,RT � �VLt Stater
Phone No. nf)l (�5D( 3 ;e Cge�i Zip Code: f3 4 cl &3 Fax: >-
E-Mail:
E-Mail: Phone No. !Ing P tic
Fill in fee simple Title Holder on next page(if different E-Mail:_!T,Vr ) P (L 6 t'jv
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:
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 tw
improvements to your property.A Notice of Commencement must be recorded and posted on the b'ta
before the first inspection. If you intend to obtvomlm�
g,consult with lender or an attorney be f C tiN
com n in work or recordingour Notice ofe� nt. =LLQ
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Signature of Owner/Lessee/Contractor as Agent for O aii!t;2 q igna ure of Contractor/License older
STATE OF FLOR!!A - 1_ii 2 STATE OF FLORIDA .
COUNTY OF Sa~ COUNTY OF •'�'`°%w
The for ing instru ent was acknowledge before m The f mg instrurynt was acknowledge fore
thisday of 20 by °' *"KGs thiday of of 20LI
Name of erson kin statement Name of person m king statement
Personally Known p IOR Produced Identification Personally Known_�OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of No Public-State of Floridly) U (Signature of Not Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17