HomeMy WebLinkAboutBuildling Permit Application 1 11
All APPLICABLE INFMUpST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /'�
Date: Permit Number: 1?v 3 j t‘ 5y.
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z _‘ ,..g..446.7, 4,:_..„,:_ ' . RECEIVED
CQ INT Y R x-- MAR 15 2018
Building Permit Application Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial. Residential V
PERMIT TYPE:
I
PROPOSED 'NPROVEM :NT ,OCATIONs: . A°-. w -p=.°.
Address: I_3 Par kl igotcQ D voe
Property Tax ID#: 3909 - 70_3-- 0 13S" 0 00 ^7 Lot No. .i
Site Plan Name: Block No. Z 1
Project Name: 1-ek) of v/004 , -edtcez
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CIJNSTRUCTIQN:INFORMATI'@Ns .: ' i
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total,Sq!Ff of Construction: (ismP '- Sq. Ft. of First Floor:
Cost of Construction:$ ODD Utilities: _Sewer _Septic Building Height:
OW ER/LE-SSE . , '. s .'` €ONTRACTII
Name 1 4i i 0 A / Name:
Address: 13)3 rpar awri 'I? / ' Company:
City: Fee r State:St Address:
Zip Code: c 47 , Fax: City: State:
Phone No. -TM- D,(,0—KU> Zip Code: Fax: __
E-Mail: Jr130001313e0 .4Ae i. Co V1/4 Phone No
Fill in fee simple Title Ho der 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.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
$J, T w . .CONSTRh Y c-riciNAD L 1N SikMA1 tmig •
°
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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF 5 LAA a COUNTY OF
The forzing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1D day of .__ ,20 (T by this day of , 20 by
)CVY (CU Q
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 Identification
Produced Produced
/ •
(Signature of Notary "u:`� ;,Slam• •rt(r)VAUGHN (Signature of Notary Public-State of Florida)
�ti
` 0 P' _State of Florida-Notary Public
.=
Commission No. _ Commis(S2al GG 270079 Commission No. (Seal)
My Commission Expires
°i is`� October 22022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW_ REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley. 9/26/18