HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1 '
SCANNED
BY
St Lucie County
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Qom^U o1, Date: ,��\� Permit Number: 1 (yn��
Building Permit Application ,RECEIVED
Planning and Development Services TEB 4 2 2018
Building and Code Regulation Division Permitting Departnlgni
2300 Virginia Avenue, Fort Pierce FL 34982 St. LuoIe�County
Phone: (772) 462-1553 Fax: (772) 462-1578 -Commercial Residential //��
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address:
Legal Description: AI
1
Property Tax ID #: i I 1 U — OU 1 LIJIJ Lot No. 11.�)
Site Plan Name: ,Q Sl�l _ i'� l rQCP� Block No. 01
Project Name:
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Setbacks Front. a15 Back: 1� Right Side:. 5 Left Side: - J
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Total Sq. Ft of Construction: & ,`� i
Cost of Construction: $
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2rs LJ Generator L qJ Roof ICJ Roof ph
S . Ft. First Floor:
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Utilities: ESewer Septic Building Height:
OWNER/L SEE
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Name (
Name: hi C I
Addre
Company: i) 1A
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Address: M2. 'i V11
City: J Q J J State:
_
Zip Cod ` Fax:
City: % 1 State:
Phone No.
Zip Code: 3,-; Fax:
E-Mail: I
Phone No. -1 .-1 93 4 - 3-37D
Fill in fee simple Title Holder on next pageq if different
E-Mail: -Crl Ca (1e W t) by 118 ers , C-or-A
from the Owner listed above)
State or County License:
If value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
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: 1
Address:
City: IV
TT
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
commenci work or recording our Notice of Commencement.
Signature of ontractor/License Holder
Sig-na'ttWe of Owner/ Lessee/ConlraEtbor as Agent for Owner
STATE OF FLORIDA
Pjj
STATE OF FLORIDA
COUNTY OF - , &Ar ,&
COUNTY OF M-Ly»
The forgoing instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this j� day of 20 r7 by
this day of , 20n by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification JL/I
Type of Identification
Type of Identification
Pro c d
P24%4
6 !'
(Signature of No
of
I'cto I ri a
(Signature of Nota r>� e of
:,,. W MMUAKLTON
IS ION # GG 146832
No.
CARRICommission
�"�: 1R'�
OMMISS� GG 148832
*
Commission No. ��j ...• e? SPIRES lber28,2021
<' Bonded Thm Mary
•,,,,.,,, Public Undetwrltms
=.'� o`.•= September 28, 2021
Bonded Thru Notary Public Undemiters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17 Tp
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