HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: 0'4 l Permit Number: O
RECEIVED
- I Building Permit Application NOV 21 -2018
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Count FL
2300 Virginia Avenue,Fort Pierce FL 34982 County,
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentia
PERMIT APPLICATION FOR:
P �OPOSED I�N�RRC}UEMENT OCATt
Address:, 6 O C
Legal Description:
Property Tax ID#:R 4,06- ':g ^ as 6 -nnt,9 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED I?E,0CRIPTION WORK:
X 2 cz! 7 s^ M^P . ►,lr>.s S'o I3er�4 �= Sh�,g�,--1� T�
tgcl r igs f- Fn l2 r ; r'�i/ rlo wa
CO'N5T•,UCTIC)' INFORMATION:
Addffio-n-a-fWork-fo ffe--p-e-ftormed under this permit-check a t.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: Utilities: —Sewer _Septic Building Height:
WNW!11110%1 E-0-0 R OR:
Name L-t,2(Ly � � Name:
Address: ,S"�B6 �'`��s�� t/ � Company:
r �
City: 1^r e rL Lam? State:L_-1 Address:
Zip Code:,q Fax: City: State:
Phone No-7 ',3 7 6 -C3' 7Zip Code: Fax:
E-Mail: `Iir9ri Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM TAIL CC3N "Will WON
STR+ JCTION LIE°N LAW iNFaURMA7 0�
DESIGNER/ENGINEER:. . . . Not ApplicableMORTGAGE 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 @.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 apermit will authoriie.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, l 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
commencing work or recording our Notice of Commencement.
0
Signature o wner/Le!rsee/ContActor as Agen Signature of Contractor/License Holder
STATE OF FLOR $ �. ., STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledgeefi ri ri4 The forgoing instrument was acknowledged before me
this day of b w z = this day of 20_ by
C 9,T O
Lad2 E ro
Name of pers n n-Akinot statement.1 Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of ti i ti Type of Identification
Produced �► �, Produced
(Signature of Not'3rb Public-State of Florida) (Signature of Notary Public-State of Florida )
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17