HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a. !� J Permit Number:
' RECEIVED
Building Permit Application
DEC 17 2018
Planning and Development Services Permitting Departmen
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Z
P OPCS D LNP.,a EMENT I.00Al'IC�3N: ;
Address: Rmcks,,,;i4 ,
Legal Description:
Property Tax ID#: 239-Jr�2—®od 00��� Lot No.
Site Plan Name: /�� Block No.
Project Name: DC44 S/e&CAL
Setbacks Front .50Back: 36' Right Side: Left Side:
DY NIL E;91 DE5SCER,IPTIQN C?F ORS
o%t'e
TR+ IMMKIN0110,809 ATIO
Additional work to be performed un er this permit—check all that appy,
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 2—Lid0 Sq. Ft. of First Floor:
Cost of Construction:$ '80,0'a Utilities: _Sewer _Septic Building Height:
o E7NORIL SS E: ` CONTRA EU
Name v J9,. Name:
Address: ,�i� s `7 Yew. Company:
City: )C�rrt Plince State: Address:
Zip Code: 3LMS Fax: City: State:
Phone No. 7.7 — $a 7Zip Code: Fax:
E-Mail: CUSJfaMme A L/rh.,. & !�i/.C.aM 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.
SUPPLEMENT L C�N�STR+UCTI�N LIEN L.AW IN��CIRMATIi�
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
commencing work or recording our Notice of Commencement.
Signature of Owner/Le Contractor as Agent - ; ` Signature of Contractor/License Holder .
STATE OF FLORIDA rn< STATE OF FLORIDA
COUNTY OF a X� COUNTY OF
2 m�
The forgping instr ent was acknowledg for Ni 'P3 The forgoing instrument was acknowledged before me
this�day of —pe-c- • 20D by this day of 20_ by
3
Name of person making statement. Name of person making statement.
Personally Kngwq^OR Produced Identification Personally Known OR Produced Identification
Type of Identificati ` Type of Identification
Produced r ( Produced
O"W�
(Signature of No ry Public-State of Florida (Signature of Notary Public-State of Florida )
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17