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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONPlanning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: All +APPLICABL�E INFO MUST BE COMPLE i eu FOR APPLICATION TO BE ACCEPTED Date:y' d•N Permit Number: / p (36b ":-)'CA NNEE BY 2L Lucie Caunb RECEIVED Building Permit Applicatior JAN 2 9 2018 ST. Lucia CoHnty, Permitting Commercial Residential PROP05fDn1NPR01/EMENT.LO:GATION. ` I Address: /,ff, / /6 Legal Description: = Property Tax ID #: �y/9 ' .53CJ " / 1`^b' - 60O - % Lot No. r-� Site Plan Name: Block No. ,39 Proiect Name: Setbacks Front Back: Right Side: Left Side: C4N5TRUCTION l'WORMATION Additional worK to be pertormed it checK all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors VElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: 750 19r Sq. Ft. of First Floor: Cost of Construction: $ , 500 �©— Utilities: —Sewer —Septic Building Height: `011S/NER/LESSEE CONTRACTOR. Name l�j9'NC /��A�/ �� Name: Address: Z3, Z ,&— /r�i9 �'�� ! i4 /id P� Company: v�/iN py11�/ �� �/�GGL � %U9 14C_ Address: /l'yD City: y70LState: � Zip Code: Fax: `— City:/U/YI &eaCA State: rz__ Phone No. % %.� % 29'/ 76 y Zip Code: 1113y0? Fax: QW ,�,a0 E-Mail: Phone No cS(pl to oCd C� E-Mail 1A'VYM,'7rk,[ig-/7'L/�e 9f%1Af/ COS Fill in fee simple Title Holder on next page ( if different from the Owner listed above) State or County LicenseCA6C (erg 7/0 if value of construction is 2500 or more, a RECORDED Notice of Commencement is required. Amk SU'PPLEiVIENTAL CONSTftUCTIC?N LIEN LAW II FORMATIQN , 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 I BONDING COMPANY: Not Applicable Name-- Name: Address: I Address: City: I City: Zip: Phone: I Zip: Phone: I OWNER/ CONTRACTOR AFFIDVIT: Application is hereb� 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 such prohibit 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 I ndergoing 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 obtainlfinancing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. Signature of Ow g/ Lessee/Contractor as Agen or Ow 'er Signature of Co ractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF �� / /.i(t COUNTY OF 41C tf-, The or oing instru dent was acknowledged before me The fo oing instr .ment was acknowledge efore me this day of 20 by this day of 2046by H 0, ley (Name of person hcknowledging) (Name of persoh acknowledging) c� (Signature of Nota-rV Public- State of Florida) (Signature of Notary Public- State of Florida ) I Personally Known OR Produced Identification Personally Known OR Produced, Identification Type of Identific on Type of Identific '8n L. Produced( Produced Commission No. .� r, o `"'��""' KAR . NIELSEN Commission No. -•'�`' `°%': Com �LN -� *= Commission # FF 115637 " ' M mission it �'%'FUF«oP`O�`' Y Commission M Commission Elx ire. June 14, 20ji 8 June, i 2, 2018 REVIEWS FR REVIEW PLANS VEGETATION SEA TUR COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED I DATE COMPLETED I ev.