HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 3-2+18All APPLICA LE INFO MUST BE COMILETED FOR APPLICATION TO BE ACCEPTED 22 /�
Date: 211 Permit Number: i v `) — Olj.1
RECEIVED...
e%®Una MAR 0 21018
' Permltting Department
Building Permit Application St. LudeCounty
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 Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVENlENT LOCATI0N..,
Address: r-)llUf( I
Legal Description:
Property Tax ID#: L_�Z/G �5' —GO % DG"O - 000—y Lot No.; ��—
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Site Plan Name: Block No. 19
Project Name: ke petj
Setbacks Front Back: Right Side: Left Side:
.,,,DETAILED DESCRIPTION OF WORK::
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"CONSTRUCTION INFORMATION•
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Additional work to beperformedd un er t isper t apply;
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_Mechanical _ Gas Tank _ Gas.Piping `Sk tters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers ;;; ,_'G'enerator _ Roof Pitch
Total Sq. Ft of Construction: I,/y!� Scj. Ft.'. -'of First;Floor:
Cost of Construction: $ Qe7, P.0 Utilities:,'.,.: Sewer _ Septic Building Height:.
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01NN ER%LESSEE:
CQNTRACTOR:
Name UUIA I
Name..
Address: Q LA-2
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Company:
City: ��1-� p�2r c� 'State: Cl
Address:-.- x?
Zip Code: 0A1 Fax:
City: State:
Phone Nfo�.,, �2 u24— 54
Zip Code: Fax:
E-Mail: u Q r 1�`�C1 Q_ d �y l� iU
Phone No
E-Mail
Fill in fee simple Title Holder on next page( if different
from the Owner.listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
EMW ION.
�a r
DESIGNER/ENGINEER: d Not Applicable
MORTGAGE COMPANY: Not Applicable
Name. '... ,_?�;, I
Neme:-
Address: I
Address:
City (State:
City: State:
,!,Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:.
Address: I Address:
City: I City:
Zip: Phone: I 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 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 that
covenants may restrict or prohibit such
structure. Please consult with your Home Owner's 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 accessoy 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,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
commencin work or recording our Notice of Commencement.
Signature of Owner/ Lessee/ tractor as Agent or Owner
Signature of Contractor/License Holder
STATE OF FLORIDA,
STATE OF FLORIDA
COUNTY OF J . LLrc,Z e I
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Z day of /n/ . 20L&by I
this day of 20_ by
c� [J/*-h �� j �, ��• No,,;
(Name of person acknowledging)
•
(Name of person acknowledging)
0,
m
(Signature of Notary P lic- State of Florida)
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(Signature of Notary Public- State of Florida )
iW _
m
Personally. Known OR Produced Identifi
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fit' aw
Personally, Known OR Produced Identification
Type of Identification
')$EL o W ze
Type of Identification
Produced P, 4—
d X
-n
Produced
b w O
Commission No. (Seal)
IN NQo
Commission No. (Seal)
ci
REVIEWS
FRONT
ZONING.
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
I
�lg
COMPLETED
3lzl
ev. 7/2014