HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE
Date: ��� Z— 0 rj r
r FOR APPLICATION TO BE -ACCEPTED
Permit Number: 1�6�' OS55
uuvRECEIVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462i 1578
Building Permit Application MAR 2 d '2018
I ST. Lucie County, Permitting
Commercial Residential X�
PERMIT APPLICATION FOR:
PRQPOSED
#NPROV,' MENT LQCAT#ON
Address:,®- y/� sou 5�5r
Legal Description: a F (,k �eS
Property Tax ID #: �J
Site Plan Name:
Project Name:
Setbacks Front Ba
131), 5-3 2-6 T Z
Right Side: Left Side:
Lot No.
Block No.
Name 502.4AJ)iP . Piic.Sc � Name: &*MIL 44�/£4/4;_
Address: Company: e22712 1zpZ,&'
City: State( Address: To Z�'.
Zip Code: ��l'i l'C— Fax: City: ff, L[- State:
Phone No. Zip Code: 3 ` -L2 —`L Fax::'
E-Mail: Phone No 7i2 — c-q- Z
Fill in fee simple Title Holder on next page ( if different E-Mail (t- L-* "b Z_+ Ce2,1A'I
from the Owner, listed above) i State or County License G T3 L 3 9- '3 S—
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
INFt��VIAT1��
SUPLEi111ENTAI�CaNSTR CTiCNL1EN.1111t
DESIGNER/ENGINEER: _ Not Applicable
.:
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:. _ Not Applicable I BONDING COMPANY: Not Applicable
: Name' Name:
Address: Address:
City: City:
Zip: Phone: 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 he 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
is in
which 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 u 1 dergoing 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 inspectioX.If yo me d to obtain financing, consult with len r r a orney before
com in or r0tVdir1#your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent -for Owner
Signature oft5ntractorTLicenseHolder.
STATE OF FLO IDA
STATE OF FLORIPA ,
COUNTY OF ��'►'--yc'�e
COUNTY OF S Lil�n�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledge before me
thisZo day of "0,4 , 20 \J. by
thisa.d day of NNV -C 20V� by
(Name of person acknowledging)
(Name of person acknowledging)
eq
(Signature of Notary P lic- State of Florida) I
(Signature of Nota Public- State of Florida )
Personally Known OR Produced Id ,fi
Personally Known OR Produced Identification
Type of Identifi ati .
cue pFANNA�C•a1ARIE GiVEPdS
Type of Identificationw,�� ;n
Produced \
Produced pEmmAmAgiEpIVENS I
�(PIRES. December 10. 20`0
Commission No. nn,t� b1lcUndenudlera
= '`�'=VLy COMMISSION # GG 022023
?�� �L!( Decembef
Commission N e —ff
naea
•.,;Fo'F�o; JFni Notary Publ n e irlte�> I
Bonded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN§
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED��+
ev. 7/2014