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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE'( Date: 3 ) Planning and Development Services FOR APPLICATION TO BE ACCEPTED Permit Number: a 1 a a3S'• GGANNU. BY "t LUCIG County RECEIVED Building Permit Application JAN - 3 1018 Building and Code Regulation Division Permitting Department 2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie unty Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: 4cc J Address: !J JUV LA& le!J V- (4 ce Legal Description: Property Tax ID #: 13 ) �K— / 3 V Q Q d I- QQ p'? Lot No. Site Plan Name: Project Name: Setbacks Front 646 Back: 14-a Right Side:_ Left Side:. Additiona1,work to be pertormed under tnis permit— cnecK an tpat_appn r, Mechanical _ Gas Tank _ Gas Piping " Sl Electric _ Plumbing I _ Sprinklers t : ' G Total Sq. Ft of Construction: s� Cost of Construction: $ A 006 Sq. Ft:`of'Frst'Floor: Block No. Windows/Doors ✓Roof ' " Pitch Utilities: —Sewer —Septic Building Height: Name �Cga Address: 14 9 00- C©n lt? /A e-g City: �; rflE E' State: Zip Code: 9411-1 Fax: Phone No. -l—yy l-9 E-Mail: C&u z-S0 m,tAQ / a i^ Fill in fee simple Title Holder on next page (if different - from the Owner listed above) Name: Company: Address: City: State: Zip Code: Fax: Phone No . E-Mail State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. �. M-is."a- 01 DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: I Address: City: ,;.. State. City: I State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE BOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name:', f Name: Address: " "' I Address: City: I City: Zip: Phone: Zip: Phone: I OWNER/ CONTRACTOR AFFIDVIT: Applicatio is hereby made to`obtain a per 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 Owner 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,lsigns, screen rooms and accessory uses-to_anotlier 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 Commencemen Signature of Owner/ Lessee/Contractor as Agent Signature of Contractor/License Holder STATE OF FLORID:-" STATE OF FLORI COUNTY OF ''°:; COUNTY OF a. ,oi, rt,, .•' The fo oing ins ent was acknowledged bef this, day 20� by —S The fo going instrument was acknowledged befo .,qi this day ' 20� by o a of . 9p v 9Mm m Name of person making statement. rn� Name of person making statement. z +p Personally Known ✓ OR Produced IdentifioiR o rn-n 9 Personally Known '� OR Produced Identific &o� Type of Identification Type of Identification �N Produced Produced' (Signature ovotary Public- State of Florida (Signature 001otary Public- State of Florid Commission No. (Seal) Commission No.. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE j RECEIVED DATE COMPLETED v Rev. 8/2/17