HomeMy WebLinkAboutBuilding Permit Application COMPLETED F APPLICATION TO BE ACCEPTED
All APPLICABLE INF MUST BE COM OR A
Date: U /� Permit Number:
RECEIVED ,
Building Permit Applica ion OCT 31 2018
Planningand Development Services
P e
Building-and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie Cou FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re
PERMIT APPLICATION FOR:
Address: ~I qZ S HIPDFN �lUFe— 5 d9 f f 65�T S r [.��-f E; l.S�t3
Legal Description5aEVD`�.!L- �` 7
Property Tax ID#: ��� - �ncS J �.o�. Lot No. '20
Site Plan Name: Block No.
Project Name:
Setbacks Front--/O Back: IC7--Right Side: LeftSide:
J,11AAa
�a-o 22 F ct' 1ti w r-/.-4 f4 I)' �(I
i lonal work to be pe Orme un Ntts permit=c h e k a I I t h at appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1L( Utilities: —Sewer _Septic Building Height:
S�rName Nam e:zGaKKz--LCs-11Q .
Address:`7 .7 /-Pi�IAE�431,,J iC4 VLS?� Company:-RS-1-K-60 L-"JJ Ck-C
City: ,OjL-( yZ e.-�LCL� State:_ Address: S`EX5 /\ j T)O-OJ-
Zip Code: '�?qFax: City:-PCW— 5T Lt.�l State:
Phone No. '77 Z-9"1'2'-3'(9:2 Zip Code: -TLt`ir S Fax:
E-Mail: Phone No S$1 _7Z'15 Z
Fill in fee simple Title Holder on next page(if different E-Mail r-ra--tE-P ti-i com
from the Owner listed above) State or County License 3Gr
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 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
corrimpomg work or recording our Notice of Commencem
Signature of Owner/Lessee/Contractor as Agen - Signature of Contractor/License Holder a. t
IN
STATE OF FLORIDA (1J m� STATE OF FLORID .A-'__f X�
COUNTY OF 'P4 L' a COUNTY OFf"
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The f rgoing-instru nt was acknowledged befo .� The f rgoing instru ent was acknowledged-before m �'�
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this�day of 20 by ca
�, Z a thisi day of 20by 8 Z
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(Name of person acknowledging) (Name of person acknowledging)
ad �'
(Signature of Notary lic-State of Florida) (Signature of Nota ublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id tifi at n Type of Id nti n
Produced Produced
Commission No. (Seal) Commission N (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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