HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ia'�S' `� Permit Number: )-t fid- o S`1
RECEIVED
Building Permit Application OCT 2 5 2018
Planning and Development Services
Building and Code Regulation Divisionrmitt►ng
2300 Virginia Avenue, Fort Pierce FL 34982 S.T.Lucie 6can�'
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �} a
PROs Ct D IM'PRtOVEM;EMT-LOCAT C}N. .
Address: �of �� 40,1 S-LL4axf F6. .57-e
Legal Description: 641Zi
Property Tax ID#: ��/ZS�— �� 110 -- [�C7p -�I AI-ce I TP Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA
IL"Ep DES iRIPTION Cl
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CONSTRt1CTI0N INFORMATION,
A iti na wor to a er orme under this permit-c ec aMShutters appy:
Gas Tank Gas Piping
aWindows/Doors
Electric ElPlumbing Sprinklers _ enerator
F] Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ f``� , 3 o Utilities: _Sewer Septic Building Height:
OWNERf LESSEE IN
CC!NTRACTOR
Name go-v- - "I ;. llk9 I'.t 7 ,
Name• �
l
Address: Fs l Ut,k Company:
City.:' R r-t- 5 IJL�� State:IL Address: .SZ_1 ,.'. :e- �".^-.� &,vZip Code: C�5� Fax:" City: State: �'L
Phone No. �,0 3 d9 ClI 8s— Zip Code: 7L( Fax:
E-Mail: Phone No. 772- 79s--- (moo
Fill in fee simple Title Holder on next page(if different E-Mail: OAe elq/ L 'N C ra,' 'o�
from the Owner listed above) State or County License: Lo ( 7Vb
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPP�E{VIENT,4`LQNST( .UCTIQN LlN,LA W INFOR(VIATlC?N
�
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
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
commen ' g work or Wording your Notipeof Commencement.
Signature of Owner/ essee/Contractor as gent for Owner Sig6aKure of Contractor/License-Holder
STATE OF FLORID STATE OF FLORRI pA
COUNTY OF 5�• \-y-L-%� COUNTY OF S}, �-��\--Q,
The forgoing instrument was ackn6wledgpl before me The forgoing instrument was acknowledge before me
this�`S day of S 20 \ CS �by this S day of S 20� by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identi 'cation
Produced D L Produced- �Q L
(Signature of Notary P lic-State of Florida 1_ (Signature of Notary ublic-State of Florida)
DEAN MQQA,,��EG{VENs�� .N�,,,..
Commission No. :tie COM31*GG 022023 ! Commission No. DEANEGIVEiJ&-
`. 'i` EXPIRES:December 18,2020 a = MY COM I Go Q22b22
� Bonded Thru Notary Public Undenmsters �o`: EXPIRES:December 16,2020 +
o�:;°� �. "%go 7� •' Bonded ThN Notary Public Ur,6�rtv»ilarr'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17