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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO `MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'l A� U `` 7 Date: C,Q I Permit Number: I I D 3 O 3H0 - RECEIVE® V Building Permit Application JUN 2 9 2018 Planning and Development Services ST. Lucie County,iPermitting Building and Code Regulation Division --- 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PR®POSEDtNPROUEMENT LOCATtC?N Address: IL OS orcktl-rl 0 AN Z -fbt4- Pi LICC,0- -FL 7q qqS � Legal Description: l Property Tax ID#: �,! 31 O e �� _ 001 ka - 000 •- oZ Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DE�SCR�I�PTtON OF WORK. It Ci� arcc - h f C(J'NSTRUCTION INFORMATION: itionaiworKtOPeperformea un er t is permit-c ec a t at app y: _Mechanical —Gas Tank =Gas Piping _Shutters _Windows/Doors J,Electric _Plumbing _Sprinklers _Generator _Roof Pitch i Total Sq. Ft of Construction: -7 5 Sq. Ft. of First Floor: Cost of Construction:$ �000 Utilities: Sewer _Septic Building Height: _ t OWNER/LE�S�SEE C©NTRAC"TOR; Name '1 A r\ u .-Na Address: A(y oS ar blmclQ.. Avg Company' City: ar4- ".`. . 49i,Zru-� State:FL Address: i Zip Code: yUl 5 Fax: -City: <.. .. .. _ .. ... State: I Phone No. � �]��- J�O� Zip Code: Fax:. E-Mail: PaG�ZScr�►ic.��lt Con-Ca51 h-�- 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 of more,a RECORDED Notice of Commencement is required. ; I I I Sl1!'PlEMENI'A!C®NSTRUCTI�N !1'E�N l�1W INFfl'RMATION.: 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/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA II . ' STATE OF FLORIDA COUNTY OF Ljj�,��, COUNTY OF The for ping instru ent was acknowledge before me The forgoing instrument was acknowledged before me this day of 20� by this day of 20_ by Mo N (Name of person- cknowledging) (Name of person acknowledging) a'tf ( ign6ture of otary Public-State of Florida) / (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification V Personally Known OR Produced Identification Type of Iden5fication Type of Identification Produced Produced REN 71'N ELSENStateq�FI rtary Public Commission No. (Seal) Commission No. _* Corn n #GG 207484 oF�,101;a°•' My Cornmission Expires June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 4