HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /� Permit Number: Q
SCANN
BY RECEIVED
Building Permit Application APR 12 2018
Planning and Development Services
Building and Code Regulation Division �, ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 I
Phone: (772) 462-1553 Fax: (772) 462-1578 III Commercial Residential
PERMIT APPLICATION FOR: Other I
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,P;ROPO.SED JMP:ROVEMENT LOCATION:
_
Address: S3 g 7 2bf;fA9=53 Cb&�
Legal Descri tion: U ���®�����}�%��/� Q .� ✓��''
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Property Tax ID #: ! "T'�®" �` �% "I "" Lot No.�
Site Plan Name: I Block No.
Project Name,:a E ^ 4!'��' C: e-
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Setbacks Front � Back: Right„Side: Left Side: /7
_D-ETA�ILED ;D;ESCR'6PTIQN �OF iWOLRK
A-<�U 67r L tee. .
CO,NSTR,UCTI.O,N JXF,ORMATION: I
Additional wor to be oerformed under this permit — check all that app v:
11HVAC L ll Gas Tank ❑Gas Piping U Shutters
11 Electric 0 Plumbing Sprinklers E] Generator
Total Sq. Ft of Construction: Sq.
of First Floor:
Cost of Construction: $ �' Utilities: L_I Sewer 1:1 Septic
I
Windows/Doors
Roof Roof pitch
Building Height:
OWNERAESSEE,:
CONTRACTOR:
Name
Name:
``,
Add es e.VY1 W?AM ° �tW
Company:
City: ���AA �"� State d
(Address:
Zip Coder Fax:City:
State:
Phone No.I�
(Zip Code: Fax:
(Phone
E-Mail:d'9419h AX c7 e'a
No.
Fill in fee simple Title Holder on next page (if different
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E-Mail:
from the Owner listed above)
SI ate or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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5URR,LEMENTALCONSTRiUCTI,ON ,LI;EN';;LAW
419,FOR MAT �I:O•N:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
Not Appli'' able
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I
State:)
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MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
I
I
City:
Zip: Phone:
!
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application islhereby 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 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 frlom 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 -Qb, tain financing, consult with lender or an attorney before
commencing work or recordine vour Not;iee df Commencement.
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S' nature of Ow PAI Lessee/Contract as ent for,6wner
Signature of Contractor/License Holder
STATE OF FLORIDA I
STATE OF FLORIDA
COUNTY OF ST, Z�A.C��
COUNTY OF
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The forg ing instrument was acknowledge before me
this ' ay of 204 by
The forgoing instrument was acknowledged before me
this day of 20_ by
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Name of person making statement I
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced J CC
Produced
,, �'4 '•• MICHAEL TODD HOLCOMB
ignature of Nota &tMV&; 'IoWFI(PN # GG107512
(Signature of Notary Public -State of Florida )
XPIRES May 23, 2021
v `
Commission No. J 1 (Seal)
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Commission No. (Seal)
REVIEWS
FRONT
ZONING
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17