HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
1
All APPLICABLE INFO MUST BE COMPLE CO FOR APPLICATION TO BE ACCEPTED
Date: L' l' �� Permit Number: 1
SCANNED
. BY RECEIVED
i qt Lucie Cou*
Building Permit Application FEB 01 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: i/,. , Y , , —,_ _ - . .
,QROPOSED 1NPROVEM,,ENT LC CATION v
Address: %U / -Alp &e : Z 3
Legal Description:
Property Tax ID #: 5 y0�L_ 609 0523 000 /q Lot No. 'tJZ
Site Plan Name: Block No. 426
Project Name:
Setbacks Front 112 Back: _ Right Side: Left Side: I
DETAILED DESCRIPTION C+F W0 K .
_. ..., ,
Ci1NNER/LESSEE.: 3
.CONTRACTOR;
Name
Name:
Address: (,2o / kcd6C 17d?_j
Company:
City:State:
Address:
Zip Code: ��i b'`Z Fax:
City: __ State:
Phone No. -792- 04;,6 7
Zip Code: Fax:
E-Mail:`(3�J�/J-/('Ue� NrT'
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 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:' _ Not Applicable. MORTGAGE COMPANY: _ Not Applicable
Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is he rl�eby 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'd o 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
o I
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 repording your Notice of Commencement.
Sign ture of Owner/ Lessee/Contractor as Agent for caner
Signature of Contractor/License Holder
STATE OF FLORIDA4
I
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instr t as acknowledg before me
The forgoing instrument was acknowledged before me
this i day of 20� by
this day of 20_ by
I
(Name of person acknowledging)
i
i
�,), l
(Name of person acknowledging)
(Signature of Notary Public- State of Florida) 'i
(Signature of Notary Public- State of Florida )
/
li
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification i
Type of Identification
Produced
Produced
I<AREN S. NIE.LS
''
Commission No. ?;` l)Commission # FF'i.1
�84n i sion No. (Seal)
4_
i' diN My Commission E
i5637
pires
it Uf ilU l
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW i
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/ZU14