HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .2 Permit Number: o
SCANNED RECEIVED
BY
FEB 0 8 2018
euillalin"d"30VO, imit Application
ST. Lucie County, Permitting
Planning and Development Services J
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 V/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: AEf—
Legal Description: )L
Property Tax lD#:
Site Plan Name:
Project Name: A I
Setbacks Front- Back: 2- 00 1- Right Side: Left Side: &0'
Additional work to be performed under this permit - Check all that apply:
—Mechanical Gas Tank Gas Piping — Shutters
Electric Plumbing Sprinklers — Generator
'Total Sq. Ft of Construction:
Cost of Construction: $ _p7qCM,co
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Name ,.41. _ R i;1.
Ad d re:ss'�1-1_5036
City: State: �L
Zip Code: 5 -J Fax:
Phone No.
E- Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height: f,
Compan ':el I
Add resg.l.
City: zlbxl f
...-
Zip Code: Fax: S-6 I -
Phone No_,s t - & 7 It
E - M a i I klt W1
State or County License I
fvc- %-e L.
I-C,a) 6ote17_,
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
NGINEER: - ' _ Not Applicable
Name: ---
Ad d ress:
City: State:
Zip: l Phone
FEE SIMPLE°TITLE'HOL•_DER- _ ` _ Not Applicable
Name:
Address:
City: i
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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
commencing work or recording your Notice of Commencement.
/ ln2,
Sig OW Lessee/Contractor as Agent for Owner
g e o tractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF�\��erjC h
The forgoing instrument was acknowledge before me
)
The forgoing instrument was acknowledged efore me
this = day of 20 by j
this � day of b 20%y
( ame of p son ackno I ging)
(Name of person acknowledging)
!gnat No ry Public�State of Florida)
gnat of otary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Personally Known Z.JOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission
AS$tN
-+
Commission N_a°_ Commission # FF�25 93
mission( s
Commission # FF 925693
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����,°nun"�� October. 08, 2019
•
Mv Commission Ex 'fires
October
08. 20
9
REVIEWS
RVISOR
PLA
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014