HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr-,
I APPLIC BLE INFO MUST BE COMPLETED FOR
Date: a
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: ,/b,
Address:
Legal Desc
VLICATION TO BE ACCEPTED
jPermit Num-�33�—
SNJ9`�6�iNEU) R ECEIVIU)
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APR 11 2018
lilding Permit Appli tionttin Department
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St. Lucie County, FL
Commercial Residential V
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Property Tax ID #: , CuCD Lot No.
Site Plan Name: --7 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CQNSi'RUCTION INFORIUTATIC}.N �a
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Additional work to be pertormed under this permit - check all that apply: e
Mechanical _':. Gas Tank _ Glas Piping _Shutters _ Windows/Doors
_ Electric �, _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $01 �' Utilities: _ Sewer _ Septic Building Height:
CIUUNER%LESSEE%•.. G NTRA00k
Name vislel
v�_I/ iVame'
Address: S 'l Compaiiy Jec =1+� ,
City: State: 'Vi_- Address:4Y ��..�t2e RQ
Zip Code: Fax: City
µ State:_C-,
Phone No. "1'77L" %l Zip Code: �,�q 9 p Fax:
E-Mail: 1YVY0A)0cL �4 �gi-�+-, .lam Phone No `-i i`L' Yfa!A_-."
Fill in fee simple Title Holder on next page ( if different I E-Mail R1-1A Z 0 7 t-04-W-1 ®Fi"t A-Ir L.. CEw
from the Owner listed above) State or County License -2%9. 6, i, 4
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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SUPLEl1/IENTt C`C?Nf` , T{I� �.IN 4LAW �NC3RNiAT[Qf0
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PE$IeNER ENGINEERi_ ` i Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Nam
Name:
Address: - V'
City: r r State:
Address: _
City: State:
u: n, , ,
_
Zip: PhdHe
Zip: Phone:
FEE'SIMPLE TITLE HOLDER: ' ' ' !Not Applicable BONDING COMPANY: _Not Applicable
Name:.f 1� Name:
Address: Address:
City: City:
Zip: Phone: I Zip: Phone:
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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 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, sighs, 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 recorde and posted on the jobsite
before the first inspection. If you intend tolobtair
jJinancing, consul ith n r or an attorney before
co encl ork or rec I our Notice o mmencement.
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Sig ture o Owner/ Lessee/Contr or.a- Agent for Ow
Signat re o tractor Icense Holder
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STATE F FLORI,DA'- _ _
STATE OF.FLO,RIDA
'COUNTY S
COUN F
OF
The forgoing instru ent was acknowledged before me
The forgoing instrumen�t>was acknowledged before me
D day of 20& by,
this i—f day of - 200 by
-this
�lnv,VIA SCG�c,.Jckr4-
Q1e� '
(Name of person acknowledging)
(Name of person ackno ledging )
(Signatur of Notary Public- State of Florida)
(Signs re of Notary Public --State of Florida
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatio i
Type of Ide tification
Produced
Ile VCv i
ds" Notary Public State.
Commission No. ���/� :j. Rozanne Marie G
• My Commission GG
f Florida ► Notary Public State of
oIFjiis on No. �� �% �� �J I)Rozanne Marie Glcgc
157135 - . My Commission GG 157
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Expired 11/0112021��-
Expires 11101:2021
REVIEWS
FRONT
ZONING
SUPERVISOR
{
PLANS
EGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
IREVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
+ R
RECEIVED
DATE
COMPLETED
6 (�
ev. 7/2014
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