HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLIC413LE INFO MUST BE COMPLETED FOR fiVA015PTO BE ACCEPTED
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Date: _ -119— 13Y "Ountv Permit Number: /I Q.D - Q cpq?
St Lucie C 11
Building Permit Application
Planning and Development Services FEB 1`3 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S - I
Address: lei
"I Legal Description..
N
Property Tax ]D#: z
Site Plan Name: ffen
Project Name: U�rae
Setbacks Front Back
"DETAILED "DESCRIPTIP WORK
Right Side:
Left Side:
C__-Das TCU-) Y_
CONSTRUCTION FORMATION- z"""
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Additional work to be nertormeci uncler this permit - check all Ma apply:
11HVAC Gas Tank [:] Gas Piping fthutters Windows/Doors
E]Electric 0 Plumbing -OSprinklers 1:1 Generator Roof Roof pitch
0
Total Sq. Ft of Constructiom S Ft f First Floor:
Utilities, - Ins igh Cost of Construction: $ ewerE]
OWNER ;LESS'EE:"
CONTRACTOR
Name tft"fe) _QDC1)4t
Name:
Addres I A(y)+of) coa W Ldet)
Company— Prel-z-e
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City: State: f-l—,
Address:,W�DX K Mdqy�bl
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Zip Code: 24q YLO Fk._1 1;3 1 40
'gity: (4-- ��)
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Phone No. JA
Zip Code: _T -1.
FL-
E-Mail,
Fill in W simple Title Holder o lnnext page ( if different
E-Mail-
inn )
State OCounty License:
from the Owner listed above)
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW3IN.FORIVIATION: "
DESIGNER/ENGINEER:
Not applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
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Name:
Address:
I
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
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FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
I
Address:
City:
I
City:
Zip: Phone:
I
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 requesteidl permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Flor''da Building Codes and St. Lucie County Amendments.
The following building permit applications are ekempt 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
m mon rinn %AinrL nr rorn rrlina pint it Kln+ira of ('nmmPnramant
Sig re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
I
STATE OF FLORID I i
STATE OF FLORIDA
COUNTY OF `�'�
COUNTY OF
The f� trume as c owledge I ore me
this ay o 20 I
I a� '
The rum t s owledged fore me
this y of 20
Name of person making statement
Name of person making statement I
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
+�rERCO^RSON
Type of Identification
ProducRA!Wa JENNIfERCORSON
Produced e rroG 155�92
.' Comm 302021
p
.' Comm'kssiorGG
R 95 '
W, EXpiF85 �ol>er 30, 2
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V IL
'ature
9j . NotatY
( ig of Not ry Public- State of Florida)
(Signature f N tary Public- Stat of Florida )
Commission No. (Seal)I
Commission (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17