HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAPPLICABLE INFO RAUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
te: OCANNED PermitNumber:
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T.� if� "I " RECEIVED
MUO-1-0-t1i St Lucie CountN
JAN 3 12018
Building Permit Application
1�1-,.-,,,.Planning and Development Services
ST. Lucie County, Permi 91 �1,.-
;Building and Code Regulation Division
300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
7 �7.771
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 0,60
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,.,Legal Description:
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Property Tax ID #: (n 04 — nk C)Q e? Lot No.
te Plan Name: QN\ 'p—c— B I o c k. N o.;
..,Project Name: A f
N NIJ
Setbacks Front Back: Right Side: Left Side:
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rtiona ertorme'dun er'thig'permit ,t,cneckaiitnata
E:1HVAC
Gas Tank E]Gas Piping
Shutters
Windows/Doors
Electric 1:1 Plumbing F Sprinklers
Generator
Roof
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Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
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st of Construction:
0 tion: $ SO Utilities:
_Sewer
Septic
86ildi'hg� Height""'i".,
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Name f\1 ;C- WO e-, 1 19 f C k e- K
Name: J�d oo-V CV,
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Company: 1,ny\�p WE) 64
Address: ar- j-
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,C e c_e_ State
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Zip Code: LNS) I Fax:
City: Lckksj\qwA
State: 41. qt
Phone 95 OFg cf
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Zip Code: 332o 1 Fax:
E-Mail:
Phone No.
'IFill in fee simple Title Holder on next page if different
E-Mail-,�ECS�co, . Q(z lohe_001�-
'��_I`r'orn the Owner listed above)
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State or County License:
'VIf value of construction is $2500 or more, a RECORDED Notice of commencement is required.
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DESIGNER/ENGINEER: Not Applicable pp
MORTGAGE COMPANY: Applicable
Name:
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Name:
Address:
Address:
City: State.
City: State:
Zip: Phone
Zip: Phone:
,FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Applicable
_
Name:
_Not
Name: b
Address: -
City:
i
Address:
City:
Zip: Phone:
Zip: Phone:
`OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as irid Cate "i,,
1 .1 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 I
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.
An consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
g g Q p Y g p s
-,,in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. jy `4i
The following building permit applications are exempt from undergoing a full concurrency review: room additions, j
r.Yccessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use .- "'Lry'
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 jobslte,�;- e�,.
<,before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
"commencing work or recording our Notice of Commencement.
iature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
} COUNTY OF
The orgoing in rument was acknowledged before me
thi)Q day of 20Lq by
Name of person making statement
Personally Known OR Produced Identification
Type of Identificat• n i
Produced
re of Notary Public -
mission No.
2 7 Ab "' 395 C s3
REVIEWS
is
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
rMi ON RYAN NMINS
MY COMMISSION # FF21
ISt*IRES April 07, 201!
Signature of Contractor/Licens older
STATE OF FLORIDA
COUNTY OF
The forgoin (nstrment was acknowled a efore me r'
this``L day of e� 20 by
i
ucn
rf
r
Name of person makin statement of 5
Personally Known
OR Produced Identification —77
Type of Identification 7.
Produced_ th,Vt
S nalure of N UTi, „�Q Florida)
_ N RYA MI
:o mission N MY r P�IAsSrc
9 MISSIO q 79r�+
FOan°�' EXPIRE$ April 07
(ACr) 33b-C 53 2ii1y
UPERVIS
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COUO TER I ROEVI W S REVIEWOR REVIEW I VEGETATION EV EWI S EV EWLE
MANGROVE
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