HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONa.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I vsq
Date: Permit Number:ZI0
VY
SCANNED
BuilBY
ding Per it A Usro�' o
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
RECEIVED
FEB 0 8 2018
ST, Ludo County, Permittl
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: ('(� D 2 - C) on -'Z
Property Tax ID #: ; Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
T!n,5\��1t n c� '3d0 irk Ofr LA"
CONSTRUCTION INFORMATION:
Acid rtiona I work to be nerformed under this permit - c�lthat ann v:
11HVAC Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $12 I o d +, (j Q
Piping
U Shutters
Q
Windows/Doors
nklers '
E
Generator
E]
Roof
Roof pitch
S . Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
OWNER/LESSEE: e_< n
CONTRACTOR:
Name I—r, QoVe Cc, .C- I' 1-1 C
Name:
Address: LA0 2(/) -pa Ck C a
ompany:
City: 0f,`j _-��Cy(1 State:�
Address:
Zip Code_'-``,.77��--'7711
: 'S';Z' X t- Fax•
City: U A AY-,Q/ R.17(_ 1 ,2 State:-E�,
Phone No.
Zip Code: -C) Fax:
E-Mail:
Phone No.'
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed abI— Iove)
State or County License:
11 Vd1UC UI LUIMFULLIOO IS ?zauu or more, a KCL.UKUrU 11101CIce OT Ldmmencement is req jr d.
R1 190,2
,SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
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: Yo failure to Record a Notice of Commencement may result in your paying twice for
improvements to your pr rty. A Notice of Commenc ent must be recorded and posted the the jobsite
before the first inspectio . I you intend to obtai ancing, consult wit lender or an a hey before
commencing work or re ing vour NoticD4yrCommencement. 11
Signature of Owner/ Les
ntractor as Agent for Owner
STATE OF FLORIDA� v STATE OF FLO DA
COUNTY OF `�� ro_M � COUNTY OF C�iV 0.tCC��i
The forgoing instrument was acknowledged_before me The forgoing instrument was acknowledg d efore me
this day of 20�by this day of '�P�[ (l.r. 20 by
Name of person making statement
Personally Known X, OR Produced Identification
Type of Identificatioti
Produced
(Signature of Notary Public- Sta
MICHELL CC
Commission No. C)=•e 'd' COMMISSION age P
. EXPIRES July 29,
REVIEWS
DATE
COMPLETED
Rev. 8/2/17
Name of person making statement
Personally Known �< OR Produced Identification
Type of Identification
Produced
Public-
(&ra&mMISSION # I
EXPIRES July 29,
FRONT
PLANS
COUNTER I ZONING REVIEW I SUPERVISOREVIEW R I REVIEW I VEGETATIEV EWO" I SEEV EWLE I M EVIEWVE