HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
SCANNED)
BY RECEIVED
Sk Lucie Cain
I
Building Permit Applica ion FEB 2 8 2018
I sT. Lucie County, Permitting
Conimercial
Residential
PERMIT APPLICATION FOR:
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Address: ve,
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Legal Description:
LeS' ) 4-3 < S CA : 41 V &
Blk
-3 -1-3 ;
Yi V,
V G 3/:i e:NnA
42 70 7-
a 67L& -mv ?zq sF)
Property Tax ID #: 1-70-3
Site Plan Name:
Project Name:
_000 it-71
Zf
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Lot No.
Block No.
Setbacks Front Back:
Right Side:
Left Side:
AClaitionaiworKtObepertormea under trus permit— cliec
—Mechanical Gas Tank Gas Piping
Electric .,,,Rlurnbi, prS ' -inklers
"
Total Sq. Ft of Construction;
/0I
Cost of Construction: $ 4/ ff 00 Litilitil
Name n/ I V I' (X_
Address: 4-0 � 7, (2
City: A a.), State:K
Zip Code: Fax:
Phone No. q _,0
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
aii inat apply:
— Shutters Windows/Doors
— Generator L-/"Roof Pitch
Sq. Ft. of ' First Floor: Z 1.
"_.Buildih`g He
s. VSeiwerfL';;� �epti
-------------
'CON_TkACT10k,.-,,,,',,-
Name: 14DV0 WA I CQCyt>k!;��
Company: %
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Address:
City: State:
Zip'Code: 1 ':S' gAl Fax:
Phone No '!;r-7 -4 --;f!5 - ZA 6( 1,5
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
!
SU'PRLEMENTAL CC)NSTRQCTI EN LAW tNFQRttiIIATtQN ,
DESIGNER/ENGINEER: _ Nbt Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name
Address: I
Address:
City: I ,State:
City: State:
Zip: Phdbe I
Zip: Pho e:
FEE SIMPLE TITLE HOL R: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: el I
City:
Zip: Phone:
Zip: Phone: I
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
in
which is 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 fi,p4 inspection.. If you intend to obtain financing, consult with lender or an attorney before
comm) encirIg Work or record)ng y6ur Notice of Commencement.
S gnobre Owne esse /Contractor as Agent for Owner
Signat re f o rector icense ! Ider
STATE OF FLORID
Li `-e__
STATE OF FLORIDA
4Li�C�,t
COUNTY OF
COUNTY OF
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The forgoing instru e t was acknowledge before me
this Z day of 20� by
-
The fo oing instru t was ac nowledged efore me
this day of 20by
(Name of pers n acknowledging) I
,`
(Nam r on� Wood
�
:?% ICmberyn M. Garwood
v-
� = Commh*n 166175422
_+.: ?`_ E>tpir�: January 16, 2022
_
;
(Si a 1rQ5i'J�n' Slpt2GE Flo i a)
Bonderon Notary
(Sign 4NO ary u lic-State of Florida )
Personally Known C1 Produced Identification
Personally Known Z, OR Produced Identification
Type of Identification I
Type of Identification
Produced Aixe,
Produced 1)M
Commission No. Cf ZU (Seal)
I
i
Commission No. 6i19aZZ— (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
IREVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
I
/
316
COMPLETED
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