HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION
TO BE ACCEPTED
Permit Number: 1 C)
Date:
SCANNED
•.
RECEIVED
t ,
Buil
MAR 0 5 2018
ing`Permit Application
Planning and Development Services
ST. WOO county, Permitting
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:
Address: 0
_
0A LA B ' 3
Legal Description:
E" i L
Pro perty Tax I D #: ��t (q` nod I V tgoo Lot No.
Site Plan Name: dA AN Block No.
Project Name: w'v
Setbacks Front Back: ZOO Right Side: I Z O Left Side:
D TAILED DE�SCRIPTIDN ®F WORK,M_ K
I
CO � RLIGTION 1NFOR+M TION•
Addiflnnal work to be performed under this permit— c eck all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters ' _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:. Sq. Ft. of First Floor: '
Cost of Construction: $ 2-60Utilities: _Sewer _Septic Building Height:
i
OWN ER/LLSSE :
CQNTR C E
Name:
Name I YIATAIX_ A. Ad I
Address: 9 3�7�n13 S-�'r,,,� ��L
Company:
City: 1'�.P State:"�
Address:
City:. State:
Zip Code: 3 Z4S'Z Fax: 41A
Phone No., J-f dY6 lI--�-Y
Zip Code: Fax:
E-Mail: i �� CcM
Phone No
Fill in fee sirhple Titie 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.
L.I ,N
NF+DR
® R,ENGI EER:`
Name: P
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
;Name':
Address:'
Address:
City:
Stat •
City: State:
Zip: 3y Phone Go
- 3kb-'Dys
Zip: Phone:
FEE.SIMPLE:TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
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.
i
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-wprk or rer.,6rding ypur Notice of Commencement.
I14,'
S'g a{ ture, f Owner/ ssee/Contractor as Agent for Owner
/OF
Signature of Contractor/License Holder
STATE FLORIDA .
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was cknowledge before me
The forgoing instrument was acknowledged before me
this day of 20ja by
s3l� , C 2L
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- tate 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 L
Produced
Commission No. EN S. NIELSE N
mmission No. (Seal)
= Commission # FF 11563
- Commission Ex ires
Jun
e 12, 2018
REVIEWS
FRONT
LAMS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014