HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMA... rED FOR APPLICATION TO BE ACCEPTED -
Date: Permit Number: iiQ 4,Lm
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Building Permit Application 4 : ; ►' �D
Planning and Development Services St. Lucie go' ni7f Z
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 St' Luc arV Wo
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROP® D I C?1/ E0
Address: e ��3vqls-j
Legal Description:1�-A 0 a-v-e
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Property Tax ID#�+ " S�e-4 `e2M ^ Lot No
Site Plan Name:( dl�jzpe W Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona wor to a pe orme un er t ispermit-c ec a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
CElectric _koe!�Plumbing/ _Sprinklers _Generator —Roof
Total Sq. Ft of Construction: �L/7 Sq. Ft. of First Floor:
Cost of Construction:$ c '� Utilities: —Sewer _Septic Building Height:
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Nam Name: L1
Addres- dam'/ j+2 Company: dQ
City. .4 L/L'�� State: � Address: l
Zip Code: Fax: City:if /� I Lo�G e. Stater
-Phone No. Zip Code:,,Uq.92 Fax: q6:5 —/U 4p 3
-� E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail AAJ JC11Xq 4Q A d
from the Owner listed above) State or County License A
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
0412812017 11:32 E&W f AX)M 5691063 P.0011001
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DESIGNE E NEER: _ Nat 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 representatlon that-is granting a ppermit will authorize thefermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or ancovenants that may restrict or pro�rtblt such
structure.Please consult with your-Home Owners Association and review your deedr 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 peals,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your fallure 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
commen R work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee/Contractor S ature of Contractor/Ltcense Holder
STATE W FLORIDA , -�—/ STATE OF FLORIDA
COUNTY OF r� / L-�.r C� � COUNTY OF
The for IX instr n#,was acknowledge before me The fQrg�ing instr nt as acknowledged before me
this, day of !� 20 y this day of 2Q�by
2fll izz� A r i2l A
( e of person s knowledg ng) (Name of person acknowledging)
(Signature of Nbt6y Public-State of Florida) (Signature of ary Public-State of Fforlda)
Personally Known_�OR Produced identification Personally Known ,OR Produced Identification
Type of Identification Type of identification
Produced ' Produced_
6u t1ERA1FO`I�'N
sue 541E�P1 ' - S ION li f F 100370
Commission No. 4�`;�se 1) MY 000ss@1110 ti mmission No. A'..'�� rMM�
t M� �1 � f' PiF3E5:MscCBiM1,2018
EKPike%%' yt�rR•. 1466 6 8ud0B4NaiwYfiavjn
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014