HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: Permit Number: o 0 61 i3
ry SCANNED',
�; RECEIVED
BY
q a IAP,•e, Oa�f�nh
Building( Permit Application .IAN 8 12018
Planning and Development services
County, Permitting
Building and Code Regulation Division � ,pie _9
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Raab- rv�e ,
P3Ro P 6SIEa INPRovEME T LOCATION
M &ess4' b 767 L
Legal Description:
Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Haaitionai worK to De perrormea unaer tnis permit— cnecK aii tnat apply:
1�
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Wind�o,�ws Doors X
Electric Plumbin S rinklers Generator Roof,"t�'«'Y°itch;'
— `.g — p — — ��" -.tj ,t
TORalS` ',Ft of,COs rt `j�yjJcf 8n: srt S . Ft. of First Floor:
Cost of Construction: $ /l dO Utilities: _Sewer _ Septic Building Height:
Name ,eL 46 l
Name:
Address: 1-91601140,gie
Company:
City: %- /e /'CC State:
Address:
rZipCode: ,341'9 2�k Fax:
City: State:
Phone No. -7%Z vZ/
Zip Code: Fax:
llina.ilsz�r s� �e �� O/M
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.
StJP IEMENTA� CQNSTE2UCTlt3N �.IN LAW INFCJRMATiON.
_e aw ,
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not'Applicable
Name:
_
Name:
Address: I' ` " '
Address:
City: State:
City: State:
Zip: Phone I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name:.- '' 1 Name:
Address: I Address:
City: City:
Zip: Phone: Zip: Phone:
I
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, is granting al permit will authorizelhe permit holder to build the subject structure
-any
which is in conflict with 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 Ido 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'ahother 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 Notq of Commencement.
14
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Signature of Owner/ Lessee/Contractor a 2fikent f r Owrier
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF6k.
COUNTY OF
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
this day,ofsd 4 20M by
this day of 20_ by
\ . 6 c ar t '� a �
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary lic- State of Florida) i
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification I
Personally Known OR Produced Identification
Type of Identifi ation j
Type of Identification
Produced L �Le��""
•.« Y P,' QE/WNAMARIE GIVENS
Commission No. ro �ycoMfAlsslq(�# s 2�03
Produced
Commission No. ' ', (Seal)
IRES:Ue
a Publi�te ee
Thnl Wotary c Unde
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
IVEGETATION
SEA TURTLE.
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW •
REVIEW -
REVIEW
DATE
"
RECEIVED
DATE
COMPLETED
2- q?
ev.