HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l QJ j
Date: Permit Number:
�. r
a
Pit-
%0 V- N 'c �: a
_ OCT Q� Z�18
Building Permit Applic tion
Planning and Development Services Pei mt-nit;ing L, rti"f�e'n1:
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 St. LUGIG' FY, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentla
PERMIT APPLICATION FOR:
PRQP(�?SED IiN ROUEMENT LOCATI(•?N
Address: ���]' S %;Ck/ f Y-
Legal Description: 1%4 I VIIJ_A XA,-7P &-2,1,r J1/Q 0-117-3
Property Tax ID#: 7— Yz 7 601 D 6 Lot No. A�y CD
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIPTION OF WORK:
e®N STIRWON ION INFORMATI®N:
Additional 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: �� C�L :Je[A-i' Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
i
0 NER/LE�S�SEE: «ONTRACTOR:
L •
Name JOLin . ��✓N� o -Si- e, L L_ e- Name: �X� U e/ZNGy
Address: 207k A-1. G✓A e,/ Company: /W 11 - -J u �'
City: � �1�hf 13111 Grt State:j=L Address: /S�Z Z2 `/�G°,C.�/✓S/>GC/��/�
Zip Code: ? Fax: City: State: ��—
Phone No. ���/� ��- .5�� �7��j l.� Zip Code: 3 61 Fax:
E-Mail: Phone No 7 22— .3106
Fill in fee simple Title Holder on next'page(if different E-Mail ,3.?+J�✓ ��% t10 f'/FS,..L�`"'I
from the Owner listed above) State or County License (:f/L-(I-1 /.?Z. fel I r
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
FTU IPI.EMENTAI 0,NOSIMR[!'�TION LIEN LAW IINF®RMATION:
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: 4zlqot 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.
lith ? -;.
Signa ure Ow /Lessee/Contractor as Agent Signature o Contra r/License Holder• "4Z
pro"* ,• �� ��
STATE OF FLORID STATE OF FLORID ` o;;►
COUNTY OF m� COUNTY OF
The forgoing instrument was acknowledged befor 'a92
rng� The f rgoing instru dg nt was acknowleefore jib a �bo
this day of 20 by z this day of 20�0 by o�N
: a Cnm
S=r
C
�Jw OnNT9
(Name of person acknowledging) (Name of person acknowledging)
(Signature of NotarV ublic-State o [ori 'a (Signature of Not Public-State of Florida
Personally K� OR Produced Identification >�Personally Known OR Produced Identification
Type of Iden)ficati•n Type of Id i is n
Produced Produced ( L.
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
L__7_