HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE LunnPLETED FOR APPLICATION TO BE ACCEF r cu
Permit Number: i "IOI C0a3
-Date:
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• JAN 112019
Building Permit Application
Permitting Department
Planning and Development Services SO Lucie County
Building and Code Regulation Division
2300Virginia Avenue, Fort Pierce FL 34982-
Phone: (772) 462-1553.,Fax: (772) 462-1578 Commercial Residential
PERMITAPPLICATI0b11 FOR: 'h ��� �'�m Dc�S�a/PYh p
Legal Description:
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PropertvTaxlD# /�3/x�/DD SF3®DD`1 Lot No. �
Site Plan Name: Block No. ALL/
Project Name: /dr. Ale,
ellb
aeks�' Front Back: Right Side: Left Side:
—Mechanical —Gas Tank
V Electric Plumbing
—Gas Piping
—Shutters
✓Sprinklerrrss
ZGenerator
Sq.
Ft. of First Floor:
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,ff�
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Utilities:
Sewer Septic
— —
Windows/Doors
✓ Roof
Building Height:
,'4
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Zip Code: Fax:
Phone No.
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State County License:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Name:
—
Address:
City: it State
Zip: W Phone /
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:. _Not Applicable
Name:
Address:
City:
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 holdef 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
I LI 1014 ld=l 114o l oil i u-7 ao tU r u a u1111
as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I� COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this Ag— day of c'. 20 I% by I this _ day of 20_ by
Name of person making statement. I Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Publil
Commission No.
REVIEWS FRONT
COUNTER
DATE
'RECEIVED
Personally Known OR Produced Identification
Type of Identification ,
rids) (Signature of Notary Public- State of Florida )
ASHAHNAINGRAM
(6ea�Public -State of Flo_ria mmisSion No. (Seal)
My Comm. Expires Dec 20, 21181.
Bondedl rou hNalienalNola ^ ssn.
I ERVISO ,r LANS VEGETATION SEATURTLE MANGROVE
JV REVIEW' REVIEW REVIEW REVIEW REVIEW