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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: l V SRO a?ssae' 1 4�••�lM�. RECEIVED Building Permit Application OCT 2 5 2018 Planning and Development Services Building and Code Regulation Division ST. LUcie countyl Permitting 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _ PERMIT APPLICATION FOR: PROPOSED LNiP� OUEME L©CATI�N: Address: l 0 t O 0 5 C L,4v C--Z- Legal Description: t2 I Property Tax ID#: 3 L�0 1 201 F206111 ' 6420 O Lot No. _ Site Plan Name: X05 Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DET ILED DE�SCR1'PTION C)F WORK: CO' STRUCTfO INFOR A ION: 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: `?i [:f�3� ��-1 `��C Sq. Ft.of First Floor: Cost of Construction:$ D_r 500 '" Utilities: —Sewer _Septic Building Height: OWNER CONTRA O Namev � t � Address: Company: ,:�'sl�s City: �i �G�r !i State: YkAll i✓ Zip Code: `t�i` Z" -:.; Faz:: City: K=%4ir0 c State: (, Phone No. `71Z C{,(a( �l� Zip Code: 3 Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail CArSTa 2Go�t,.r� from the Owner listed above) State or County License i,bZ 19-1. CGG os'S-S 7.3 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SU 'PLEMENTAI.C«�NSTR�UCTION LIEN LAW INFORMATIQ 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 thepermit 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 recorde osted on the jobsite before the first iLL&Wc ' . you intend to obtain financing, consult wit I er or n attorney before commencing rk record' a your Notice of Commencement. Signature of Owner Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDAU STATE OF FLORIDA COUNTY OF COUNTY OF L The forgoing instr ent as acknowledge efore me The fing instru t s acknowledge efore me this day of 20M by this 6 y of 20 by NLt Name of person ma ng st ement. Name of person making statement. Personally Known OR Produced Identification Personally Known �// OR Produced Identification Type of Identification Type of Identification Produced Produced ( ignature of Notary Public-St e „ ature o5ot Public-State of FloridaBl KAREN S. NIELStage of Florida-Notary N fission °SBI,. KAREN S. NIWN Commission No. _' •��l)nmission #GG 20 ' P=sra}p^sFlorida No blit M.y,Commission Expi es •c-Commission # GG 207484'June 12 2 M Commission ExniraQ " June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS V GROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED �ev. 8/2/17