HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1
Date: 2� 22>1 %7E> hermit Number: ' v
KANNEU
RECEIVED
Building ermit Application g pp APR 0 3 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial. Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMFROUEMENTrLO_AT IONy r
Address:
Legal Description 43rye_ PlaIl'4c4fion --�CLS•e Di A LcD-} —73
3or Lo -a, Le 1 05�
Property Tax ID #: (— 2>6)3�C)O� � — C)Do— C) Lot
Site Plan Name: �(�l� �[�-� , I� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF WORK w'
=rl54ca qaL ( on 6:Do s -Far) Iz
40 Gfnerc_t_+or --rl n o1 C Q► 0eC,f
CONSTRUCTIOyN INFORMATION
o
Additional work to e . e orme under this permit— check
FHVAC Gas Tank ❑Gas Piping
all
apply:
_ Shutters
Windows/Doors
Electric ❑ Plumbing
Sprinklers
1:1 Generator
F]
Roof Roof pitch
Total Sq. Ft of Construction: y
S . Ft. of First Floor:
,fq D
Cost of Construction: $ �i `� Utilities:
_ Sewer Septic
Building
Height:
OWNER/LESSEE:
CONTRACTOR:, ;
Name ) �J
Name:
Address: LD '� ' `'
n
Company:
City: state ��
Zip Code- Fax: —,77 —.)City:
Phone No. 01— —, 3� 1 _
Address:
l-e (2 ate:
Zip Code: (3 Fax M: a-��
hone No. — L5440
E-Mail: -
1 : t
Fill in simple Title Holder.on next pa (i i Ae nt
from the owner listed above) '
E-Mail:
State or ounty License: mcu
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable I
MORTGAGE COMPANY: _ Not Applicable
Name:
'Name: . ;;
Address:
Address:
City: State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: I 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 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 requested permit, I o 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 work or recording our Notice of Commencement.
I
4Signatu&reof
Signatur of Owner/ Lessee/Contractor as Agent for Owner
Contractor/License Holder
STATE OF FLORID, A
O
COUNTY OF lV�
COUNTY OF ,� Vl
• -A,
The Wroin instru n as acknowledg efore me
t 'y of 20rVby
det
The f rgoi instrum nt wa a nowledged re me
thiof 20,aw
0,6k_d�
In rp, I
T�n 6e
Name of PeZ making statement
Personally Known OR Produced Identification
Name of person making statement
Personally Known V OR Produced Identification
Type of Ide 'fi at' ,n
�� L
Type of Identificatio (��
Produced (�VI'Son <u I`—�uy�
Produced `CLAY)
-<
i ature of Notar Public- Sta f&Jorida)
(Si ture of Notary Public- State of Florida )
Co mission No. �``�\\\FER�CO/��
Commission No. ". (Seal)
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0TARY `N:
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REVIEWS
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UPIERVISOR
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MANGROVE
COU�SJER�o
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DATE
RECEIVED
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OF F1.���``�\\
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*DATE
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COMPLETED
Rev. 8/2/17