HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) , n )
Date: ) D 5-" Permit Num --/- /-� D.!
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CCII JT OCT 5 2018
FL D R 1 on
wi Building Permit Appli ation
Planning and Development Services ei Bitting uepE tmient
Building and Code Regulation Division S).• Lucie C U nty, AFyL
2300 Virginia Avenue,Fort Pierce FL 34982 ;T -
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 1 \
PROPOSED ONPR®VRMEIVT LOCATIONE
Address: f gf 2 42.€4 ll,I d ,r' / ..11; ! ( 3� (9.2 1
Legal Description: C4 ® tQc e1 Lot
41,' 14 lv (a 5>16) 44)445
t �at7- 6�2)
Property Tax ID#: Zy��j' 5dl-OOC)'0O010 Lot No. /0
Site Plan Name:_CS�' ( t c`F Leyjc 1,41 Odd Block No.
Project Name:
Setbacks Front Back: Right Side: to f Left Side:
DETAIPM DES@R PTION Cy WORK
ti11 di-v1 14)y a 4.7f' /7/4C ce h. •Jar 7 (ofAA 0 €05/4/r
V✓ / �-`71'r t_5-1 .6 -4'
I CONSTRUCTIO DNFORMATIONo ' . -- '
Additional work to be performed under this permit-check all that apply: I'
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
—Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: [aU Sq. Ft.of.First Floor:
Cost of Construction: $ 6 ?, Utilities: _Sewer Septic Building Height:
.. ; . .. , a .
OWN ER/LE�S�SEE3 e ,a . x` CONT°ACTOR° . § -
Name Aker.$ / Sc e,k *01 Name:
Address: / /2 t42G( 1�%G7d Company:
City: , State:, '( Address:
Zip Code: 7101 92 Fax: .,--
ax: / City: State:
Phone No. 772- 5 V Zip Code: Fax: i
//JJ
E-Mail: i $ , r .A('i -,hj sL,C _ . Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
.
SU PL.EgrNiTAI- C6NST:1UCT 6N " IA& RMFaRMATC No ' '
3
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
improvem- is to your a •perty. A Notice of Commencement must be recorded and posted on the jobsite
before e f rst insp- ti. . If you intend to obtain financing, consult with lender or an attorney before
corn, enc'., : wor.'or, r-cording your Notice of Commencement.
S': ature•of 0', er/Le,:ee/ ontractor.as.Agent for Owner .Signature of Contractor/License Holder..• .
STATE OF FLORI / STATE OF FLORIDA`. '
COUNTY OF I COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 5 day of C9--ej'• , 20)'by this day of , 20 by
Lc CR 'W)
Name of person making statement. Name of person making statement.
Personally Known VOR Produced Identification Personally Known OR Produced Identification
Type of IdentificationType of Identification ,
Produced "" AUDREYB.HUMPHREY K•duced
•`a P
d?..kji ° ..?*5* - . MY COMMISSION#FF 174772 . '
/� /'F � �""� EXPIRES:March 6,2019
y �;,q��F;4.•' bonded Thru Notary Public Underwriters
(Signt re of Notary Public-Sta Florida ) (Signature of Notary 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
2ev. 8/2/17