HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO_ BE ACCEPTED
Date: " �"'� Permit Number:
i1 A A A I A 1 r-r%
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s� SEC I D
Building Permit Application $ PP APR 13 2018
Planning and Development Services
Building and Code Regulation Division pe rm itti n g Department
23W Virginia Avenue, Fort Pierce FL 34982 Ct(-
Commercial Re idi'il�j�J-UC1e CoCOUnty,
Phone: (772)462-1553 Fax: (772)462-1578
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATI(3N
Address:
f'S ✓C(�—�3 rG`lS�-
Legal Description:
Property Tax ID #• / - I Lot No.
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Site Plan Name: CY&Z4 OMGe M1 Block No.
:Project Name:
Setbacks Front, Back: Right Side::, '!Nh-o Left Side:
DETAILED DESCRIPTION :OF WORK - -
CONSTRUCTION 1 - i MATION
Additionalwor to e performed un er t is permit -check a 'apply:
nHVAC 0GasTank []Gas Shutters ❑ Windows/Doors
Piping _ _
[]Electric ci Plumbing OSprinklers Generator Roof
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Total Sq. Ft of Construction: S . Ft. of First Floor:
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Cost of Construction: $�� d Utilities: Sewer Septic Building Height:_
OWNER/LESSEE :
TRACTOR
Name
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Name:
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Address:` f v',' r-V-
Company: r
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city. _ T f �C.��7�, State•-
Address-
Zip Code:: ' l Fax:
City: Ff Wi trove- V State:
'Ji'a- 3- i'a /�
Zip Coder jF� �� Fax:.
Phone No. �3�`"
E-Maii;
Phone No.
_1i.114-
Fill in fee simple TitleHolder on next page ( if different
E-Mail: d
from the Owner listed above)
State or Coun •tense:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required-
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: 1_Ao11i oZS 4,2
411.E
Name:
_
Address: 136 3rr 54 i/o
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Address:
City: 4--r--cv w
,76a
State: L�',�
City:
State:
Zip: 33 Phone 7.a-'� 6�3
CiocJ
Zip:
-Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY: ;
_Not Applicable
Name: P r
Name:
Address: GG,/ f
Address:
City: kl r�ej' vm c
City:
Zip: Phone:
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 requested pern
in accordance with the approved plans, the Florida Bu
The following building permit applications are exempt
accessory structures, swimming pools, fences, walls, si
I do herebt agree that I will, in all respects, perform the work
ig Codes and St. Lucie County Amendments.
mundergoing a full concurrency review: room additions,
:1 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 th lender or an attorney before
commencinL7 work or recording vour Notice of Commencement
AV
Signature o Owner/ Lessee ontractor as Agent fo
i
Signature of Contractor icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF hiCGt�
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COUNTY OF
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The f r oing instr ent-was acknowledged before
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The for oing instru ent wa acknowledge fl before
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this -!6 da 20 by
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this day o 20 by
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(Name of person acknowledging)
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(Name of person acknowledging)
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ip N
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(Signature of ary Public- State of Florida)
(Signature of ry Public- State of Florida )
Persona nown OR Produced Identification
Person y Known OR Produced Identification
Type of I ion
Type o n
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE{(t
i
RECEIVED
i�Il
DATE
COMPLETED
Rev. 7/2u14 0