HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONII All APPLICABLE INFO MUST BE
(
Date: / . av - I
Wl-
ED FOR APPLICATIOP,,I TO BE.ACCEPTED
Permit Number: POV
By
�4 G ao�lp P�
EIVED
Building Permit Applica !REC
APR 2 p 2018
Planning and Development Services Permitting
Building and Code Regulation Division bejJcirtij'1ent
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie- C ntyr FL
Phone: (772) 462-1553 Fax: (772) 462i1578 Commercial Resl en
PERMIT APPLICATION FOR: D "C���
Address: ICJ G<
Legal Description:
sw Cki(\- . <Fb,r-� i ��. 34
Property Tax ID #: i!7" T / O "
Site Plan Name:
Project Name:
Setbacks Front Back:
CP—
Haamonai worK to oe perrormea unc
_Mechanical _ Gas Tank
_ Electric _Plumbing
Total Sq. Ft of Construction: Z 40i
Cost of Construction: $ 9,000
Lot No.
Block No.
Right Side:" Left Side:
ro�R?K:
s I h, \_e.J-Ck_L-00
s permit -cnecK an tnat apply:
_ Gas Piping Shutters _ Windows/Doors
_ Sprinklers _ Generator _ Roof 41 IZ Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
®WNE LE -SSE
'MITIRACTOR;
Name A94 & o 12z-;--
Name:
Company:
Address: 40 D n
Address:
City:-!l I State
City: State:
Zip Code: ?i cJ 9 y 2 Fax:
Phone No. ,%77,,2- 3 5� -
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above) i
State or County License
II If value of construction is 2500 or more, a
Notice of Commencement is required.
v
i
STRU N lIR L l.All1+ i'NFO►R
ION:
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: Not Applicable
-Name: ,.:,
_
Name: :..:....
-Address:
Address: -
City:' State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:, - . _ Not Applicable
BONDING COMPANY: _Not Applicable
Address:,
Name:
Address:
City:
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 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 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 your Notice of Commencement.
Signature Owner/ Lessee/Contracto s Agent
STATE OF FLORID
COUNTY OF w
The fArgQing instru ent was cknowledgefo PU
this day o 20 by �_
�a
orr
.
person acknowledging)
(Signature of tary Public- State of Florida /
Personally �o t OR Produced Identification
Type of Identificatio '
Produced C
Commission No. _U_(Seal)
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 OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
"REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 112014