HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEf ED FOR APPLICATION TO BE ACCEPTED
Date: aLA Q,4 � Permit Number:
RECETVED
Building Permit Applic tJOA B $ 018
Planning and Development Services ST. Lucle County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 C',Ommercial Residential
PERMIT APPLICATION FOR: 51 ab
r ddre`ss%oi
Legal Description: Ike �' '72,23 f oP `t4Z- A✓ �zz 23 C, * Y�ke W / t 0 F -vcci` (p-t7 zz3 e l 5
iPfop ty;Tax:ID{`# „� _ O �u�D -�O - 6B8 �� Lot No. �Z
Site Plan Name: Block No.
Project Name:
Setbacks -,,Front ' fi Back Right Sides �qti �Left�Si_de:�dU� * r
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DE1'AILED DESCRMPTfQfti1 QF WQRK.
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Aaaitionai worK to oe_pertormea unaer tnis permit- cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
l otal S`q `Ft of Construction: 4 �®,b Sq. Ft. of First Floor: r
s, t '" {� _ X Septic Building Height:
Construetion $ Utilities: Sewer
a-"rne; _`A!N a4 /Ie IS-yigrn Name:
mow:_•
Address: 'Company:
City: Jr Igely-ao rL- State: rL Address:
Zip COde:_4gs9Z Fax: City: State:
hone No. % 2-•.. 5 7 q - 3 Zip Code: Fax:
E-1VI'a"il 2cv,neVn 9� Phone No
Fill: in,fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:.
City: yJ
Zip: —,Phone—
FEE SIMPLE TITLEHOLDER:
Not Applicabl1. e:, ',,MORTGAGE COMPANY: _ Not Applicable
:.Name: -
Address:
State: City: State:
Zip: Phone:
NotlApplicable I BONDING COMPANY: _Not Applicable
Name: I
Name:
Address: I
Address:
City: I
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 its 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 arelexempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory.uses to anoth& 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
commencingwork or recording -your Notice of Commencement.
eLessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S� • Lye—
COUNTY OF
The forgoing instrument was acknowledged' before me
The forgoing instrument was acknowledged before me
thisday of fir' 20AA by
this day of . 20_ by
S Owe► v, 4, 9. 11 a c
(Name of person acknowledging) I
i
I
(Name of person acknowledging)
(Signature of Notary P lic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced (Identification
Personally Known OR Produced Identification
Type of Identification ��
Type of Identification
Produced V- - �-- �S�IyNAMXR1EOlyE4s
Produced
•°qv" ,: MY C2021
oMtdISS10N be 162 020
Commission No. . e ' �__ i$EiBi DecePl" ,l dervj laws
. Commission No. (Seal)
r�iied (hruhlotaN
govaoec go001/
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
I
�� f� S
COMPLETED
Rev. 7/2014