HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP1.6-f- i FOR APPLICAT1ION TO BE ACCEPTED -
Date: �J"'�.� r l � Permit Number:
VIG -6S41
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: r
SG AN ED
RECEIVED
Building Permit Appli atiiR 2 0 2018
ST. Lucie County, Per itting
Commercial Residential
Address: —V i 07b
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Z V_)10 I
Legal Description: ] 06A)
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-15., Less W4
\AA- Q56 1 2 5
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Back:
Right"Side:
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Left Side:
Lot No.
Block No.
` bcy n Po'
Additional work to be pertormed under this permit - cneck all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: U09 LF Sq. Ft. of First Floor:
Cost of Construction: $ 1600 ' Utilities: Sewer —Septic Building Height:
KU,1ltN, R/LE-�SSEE:
C®NIT, RACT R
Name ✓ e-vf_ Z
Name:
Address: CA
Company:
City: �-t P\ e1( C� P , State:T-L-
Zip Code: c3 �40i Fax: _1-1 a' u co S- 90 a a
Phone No. i a - oZO1- 5's l7
Add ll ess:
City:State:
Zip Code: Fax:
Phone No
E-Mail: �Fr12S� ga�mez�(oell��n ' n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State'l or County License
If value of construction is 2500 or more, a RECORDED Notice of Comme icement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _I Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: I State:
Zip: Phone i
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address: !
City: I
Zip: Phone:
i
City:
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 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 1requested 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 Lion -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
commenting workA recording your Notice of Commencement.
Sign ffe of'C in �e/ ontra�' Agen for Owner
I
STATE OF FLORIDA
COUNTY OF 'SAP
The forgoing instrument was ackn Iwledge before me
this�a day of T NO64 20 V by
(Name of person acknowledging)
(Signature of Notary Iiblic- State of Florida )
Personally Known
I
OR Produced Identification
Type of Identificatio
Produced '� �.
•aYd •. I DEANNAMARIEGIVENS
MY COMMISSION # GG 022023
Commission No.
EXPIRE 'De mbse16,2020
UndenJritsrs
; ••• ondedThniublfc
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known _
Type of Identification
Produced
Commission No.
OR Produced Identification
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW-
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014 \