HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 '� l• 1 _ Permit Number:
RECEIVED
Building Permit Application OCT 2 5.2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial ResidentialI _
PERMIT APPLICATION FOR: Qvo
Address: 1 n [ 0 OSCC=OLA -DVC,
Legal Description: Z2 1 6 1- S Z-
Property Tax ID#: 3 L `1 201 4=621 C OO- O Lot No. _
Site Plan,Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
To Q��'►/►^a v� IU/J_ � ����i ��i �N tS�J� 6�-� r-�G/r v_LCi-- � �' 1 -
Additional work to ,e performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator ,Roof (VJ- Pitch
Total Sq. Ft of Construction: 99,0- t `t- Sq. Ft.of First Floor:
Cost of Construction:$ 6t;;' Utilities: —Sewer _Septic Building Height:
Name Zoee;*- Name:
Address:. (04,6-- 0,5 1_ -C>W- Company: .Cksc��l
City:-]E� ' A5lla r- State: , Address:
' Zip Code:,: `ta.�'Z . Fax:: City: t:�4. 4��, rz State: `(.
Phone No. -77Z 4(o( �`l� Zip Code: -3 q!2a?l Fax:
E-Mail: Phone No -)i-2--
Fill
7ZFill in fee simple Title Holder on next page(if different E-Mail v v4-(k Cs'r
from the Owner listed above) State or County License bZ 5�q. /�CGG pS'S3 Z 3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 herebymade 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 recorde osted on the jobsite
before the firUrk
c ' you intend to obtain financing, consult wit I er or n attorney before
commencing record' our Notice of Commencement.
Signature of Owner7 Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA 4J •—
COUNTY OF COUNTY OF
The forgoing instrur nt as acknowledg before me The f "ng instr as ack wledge efore me
thi day of 20 by thi d of 20by
P1,
1eVr
Name of person.ma7�011
tement. Name of person making tatement.
Personally Known Produced Identification Personally Known 17 OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota A NI ELSEN (Signature of Notary' Public-State of Florida)
`��tPOY POB.
;_° ;State of Florida-Notary Public
Commission No. *_ )mmisJ5R8I# GG'207484 Commission No. ,,,,
My Commission Expires ;±°� YP�°k=State o F o�S• NIELSE
June 12, 2022 �e
.c da-
SSion #GG 2074 4
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION �LE v o, n' 2Eire
COUNTER REVIEW REVIEW REVIEW REVIEW RE
DATE
RECEIVED
DATE
COMPLETED
Re—v.