HomeMy WebLinkAboutBuilding Permit Application Nov 26 2018 10:28AM HP Fax page 2
ALL APPLICABV INF MUST BE COM LETED FOR APPLICATION TO BE ACCEPTED
Date: sfi Permit Number: 5�
RECEIVED
wilding Permit Application NO 22 6 2018
Pianriing and DevelopmeritServi--- ST. Lucie Count s PYMI} titl9
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498
Phone:(772)462-1553 Fax:(772)46 -1578 Commercial Residential
PERMIT APPLICATION FOR: T Select from dropbox, click arrow at the end of line ( C,
IN
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Address: 6 Q !1 \�`l�idU S 's—i.J— jQC:A G
Legai Description: ' a S
a 4 ry a rr7 eAi s r .3 — 3 3
Property Tax ID#: _5:D —" 6_01-0 6' —0 d o "" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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i' 01 1 n,r �„ 1
g tv t L i e. f
560JJ MAry Jr'�t; ��3� f Li- _ ��;W he.��" i Seer
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Additional woric to be ner arms uncle r this perm it—check a app y:
HVAC ;Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing FSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 4 Sq.Ft.of First Hoot;
Cost of Construction:$ _ e d Utilities Sewer L..=!Septic Building Height:
Name . Name: f1te ey11,14 1,S
Address: Cl} Company: P 1I rdrG �
City: Iv eN State: Address: 6
Zlp Code: .2!141.0 Fax: City: Teri Pi er r1_ State:
Phone No. �� �?''" '� ^ a'7Q 4 Zip Code: 1�5 PA Fax: 1,, Sd—J!"J3
E-Mail: E- Phone No. G-- CG
Fill in fee simple Title Holder on next page(if different E-Mail: G:.r Co w_�✓'r Ac I,T j on ao i CO P-)
from the owner listed above) I, State or County License: ►��c )�'/So �tS
If value of construction is$!SOO or more,a RECORDED Notice of Commencement is required.
Nov 26 2018 10:28AM HP Fax page 3
• i
n• s t {
DESIGNER/ENGINEER: Nat Applicable MORTGAGE COMPANY: Not Applicable
Name: RENE
�4 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 apermit 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 Horne Owners Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requ6sted 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,fends,wails,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:.Your failure t�`r 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
commencin work or recording ourlNotice of Commencement.
Signature of Owner/ essee/Contractor as Agent for owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L r� .�P COUNTY OF_ 5 r L
1
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisdayof N-ed•Y6 rnn�ef 20 by this, dayof-lidVGr'%LAr 20,J# by
F t�! ft y1
Name of person making statement Name of person making statement
Personally Known_X OR Produced Identification Personally Known X OR Produced Identification
Type of identification Type of Identification
Produced Produced
MIr1
SA M nie An
gtgrl� A�$NtY01i
(Signature of N 1 (Signature bii
BaMrd'MxlJohryllbletirfKr km
Commission No. AOA 3 5dr�a (Sall Commission No. • ea
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17