HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST/BE MPLETED FOR APPLICATION TO BE ACCEPTED y NX Date: Permit Number: �
IF
RECEIVED
Building Permit Applicati OCT 18 2018
Planning and Development Services ST.Lucie County, Permittirig
Building-and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: Ul 2c� �I'S l o ci
Legal Description: ?o ��- J `Z �� I/r
Property Tax lD#: 301-- S-00 �(� C)—��3 CD�Z, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
r-
Additional work tc ape [)r.med inder this permit-check all that appy:
_Mechanical- _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric P'=:Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
of
.Cost of Construction:$��2 Utilities: —Sewer —Septic Building Height:
Name C0RCe Name: /I%``rl,,`yul�,r
Address: 4 I �^u o L Company:
City: pS L State: Address: /7Z s -�W
Zip Co e: 3 Yl f? Fax:// - city: 12 G State: C
Phone No. 3 / Sw cl Zip-Code:,; ys ff` L Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County Licensee -f7G
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
1�
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 a itions,
accessory structures,swimming II;
po ,fences,walls,signs,screen rooms and accessory uses to anothe n-residential use
WARNING TO OWNEY.:Yo failur .to Record a Notice of Commencement ma sulk' our paying twice for
improvements to y fir pr erty. Notice of Commencement must be rec title d osted on the jobsite
before the first ins ecti . I y intend to obtain financing;consult witnd or attorney before
commencing wor or r co i our Notice of Commencement.
Signature of /Lessee/Contractor as Agent for Owner Signa t of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORDAI
COUNTY OF COUNTYOF
The forgoing'instru . nt a cnowledge before me The for o'ng instrum t w`a knowlecla fore me
this day of 20� by this Tr
of 20 by
P7)Nc-r Hcr
�zra��a
e of person acknowledging) ame'of person acknowledging)
otary Public-State of Flori a) (Signature of Notary Public-State of Florida)
OR Produced Identific
Personally Known ationjlr_�l Personally Known OR Produced Identification
J!�"
.Type of Ide ��P Type of Ident cap DAWN MILONE
Produced .=inti '�= DAWN MILONE Produced ? '• = GG 049998
;r ISSION#GG 049998 '�= EXPIRES:March 22,2021
" �o;� EXPIRES:March '•%
Commission ,$ ;,.�' BondedThruNotary Publ��nM�vrlters
Commissio Pf�;o�ase BO°'� +�etaryPublic er
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.