HomeMy WebLinkAboutBuilding Permit Application J
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: G� S~ ' ( _ Permit Number:
«mv q�Aa i
RECEIVED
Building Permit Applicatio n OCT 0 5 2018
Planning and Development Services
Building and Code Regulation.Division ST. Lucie County, Permitting`
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772).462-1578 Commercial Residential
PERMIT APPLICATION FOR: v�
P' M SED
Address: 5 �� �� ��� ��✓�
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ac CA D lLED DE=,CR�f�PTlON � WC)RK .
)4r) e our- '2 .s- o/t/ /o
tick r
Cfifl' 1"RUMT INF®R ON. K
Additional work to be pe ormed under this permit-check all that appy:
echanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 2., Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height: .
T�..-.�
Name ' C. Name:
9�// C; ( /
Address: . I P—oi �(OF 'r7 #� Company GfJ/,l/l - iv1` l lily
City:�1J C�M�Oh�6-� State: C - Address. S-
:. _� ... /
Zip Code: Fax: City: L State:
Phone No. 7 Z4 e,6 (0 -3s—
Zip Code: Fax:
E-Mail: Phone No Z 4
Fill in fee simple Title Holder on next page(if different E-Mail G✓(w Co ofin,9 V vokoo,®fin,
from the Owner listed above) State or County License rZ�
Lvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
r
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Not Applicable
Name: Name:
Address:.- --- _ _ Address:
;City: y' -_ State: City: State:
'Zip: Phone . Zip: Phone:
FEE SIM' PLtTITLE 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 buil&,the subject structure
which is in conflict with any applicable.Home Owners Association rules,bylaws or and covenants•that may restrictbr prohibit such
structure.Please consult with your Home OwnersAssociation and review your deed for any restrictions which may apply.
Inconsideration 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,screenrooms 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;
I ,
STATE OF FLORIDA STATE OF FLORIDA -
COUNTY OF COUNTY OF _ _L Mae-
The
.. -
The for oing instru n gas acknowledge efore me The f oing instru n s acknowledged efore me .
this day of 20 by this day of 20-by
Name of person making stay ent. Name of person making statefn4nt.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification ✓
Type of Identific Type of Identificatio L
Produced DL Produced
Ad
(Signat re of Nota ri a NIELSEN (Sign ture of N -
Public , f•Florida)
State of Florida-Notary �,,,,,,,
== CorrimissiG 207484 q.�sv�•P�e,, KAREN S.`N)EN ,
Commission No. _ A. fires CommissionN = ,State of Florida-N ublic
,g n Exp
o� �'` l`!iv C��RB'ti2' 2O2Z �yF
commission #GG 207484
o �' My Commission E
une 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIONSE ROVE
COUNTER REVIEW;; REVIEW- REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.8/2/17