HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `ay• SGANNED Permit Number:
T 11� qta Coft
Building Permit Application
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
ISO 1- 0 5qo-
RECEIVED
JAN 2 4 Z018
ST. Lucie County, Purmltting
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
ME
Address:
Legal Des
Property Tax ID #: N43(e-510--00o'3.OM-3 Lot No.q_
Site Plan Name:
Project Name:
Block No.
Setbacks Frontr .-Side:
1� p v a
�' Yd Isle �
1
0HVAC
"Electric
LJ Shutters
0 Plumbing Sprinklers I Generator Roof Roof pitch
Total Sq. Ft of Construction: lqeS Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer FSeptic
Name NJtC*AQlCtS VIt-HOVI
Address: N (Q O NJ ill.2 Re-6 mf k.r- R&.
City: PoArA U-4-44 State:
Zip Code: 34g01 y Fax:
Phone No.-2:3 j O
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
QWindows/Doors
Building Height:
Name: 1113da`p L Iec+r� da n %ng,.�n
Company:
Address: bi'aq I �Qfr
City: wt 94AM ►3 fn State: r—L
Zip Code: 3341'Z Fax:
Phone No. say I - 1�qQ- II,
E-Mail:
State or County License: r(� E_C 13 067
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
te:
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 vour Notice of Commencement.
%) , CADI C- y' C llv%-�_
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLOI�rI,D�
COUNTY OF a U'�'1 Q�QG h
The forgoing instrument was acknowledged before me
this 10 day of kCh,0" 20-& by
.N fOelbIU—S W. C,I�
Name of persag making statement
Personally Known OR Produced Identification
Type of Identification
Produced _
of Notary Pu
Commission No.
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
COMPLETED
Rev. 8/2/17
."� q, 4i�
of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Pq I o ! qj,'
The forgoing instrument was acknowledged before me
this_to�day of A4rL[1! ✓► 20 jT by
Name of perso making statement
Personally Known OR Produced Identification
Type of Identification
Produced
JENNIFERWEIGEL (SignaKre of No�77/2
y Public -St ` rida JENNIFERWEIGEL
OMMISSION # FF 106987 =+: +_ MY COMMISSION # FF 10691
Pfr�IRES: July 26, 2018 E('IRES: July 26, 2018
fuNotaryPublicUnderviriters ommission No.b I 'eo,��o?•`'(4M 1hru Notary Public Undervii
ZONING SUPERVISOR I PLANS VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW