HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �11"11 Permit Number: \ 1-WA f (3sg 5
SCANNO RECEIVED
Mail
1%
=---- — - - (Rig e or i� P.�oos l
Building Permit Applicatic n APR 19 2018
Planning and Development Services
ST. Lucie County, Permitting
Building and Code Regulation Division
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 IMPROVEMENT LOCATION:
Address: � ����-n�•/1 ��-, I I L n
Legal Description�ly�� � �QL--►" I� I Ltf) I T C9 lam -
Property Tax ID #:
Site Plan Name: _
Project Name:
Setbacks Front
• ROOM• ��•
Back: " Right Side: Left Side:
DETAILED DESCRIPTION„OF WORK:._ .,
�n 64611 a S0 q61(00 'P CCLS -b,-A �L �-o
Lot No._
Block No.
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit- check all that apply:
�1]HVAC Gas Tank Gas Piping' _ Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S I
Ft. of'First Floor:
Cost of Construction: $ Utilities._ Sewer Septic Building Height:
OWN ERAESSE E:
CONTRACTOR:
Name
Name: i°
Addressl6 C_6 d -L3 •
Company (
�J
City: P (� ---�� State: R--,
Zip Code O� (ax;! Irk
Phone No. - H• _D" — cq
Address:
City: i --1 State.
Zip Code:349 Fax. t 3�
Phone No. — UQ -
E-Ma'I: 1 ,
Fill in Lee simple Title Holder'on'n `t page (if differen
from the Owner listed above)
-Mail:
`
I
State or County License.
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN. LAW INFORMATION:
DESIGNER/ENGINEER:: _ Not Applicable
MORTGAGE COMPANY: Not, -Applicable
Name:
_
Name: .
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: __Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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
bylaws
which is in conflict with any applicable Home Owners Association rules, 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 exejnpt 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.
ep i
��d& ("010, _,410'a
�6Signature
ignature of Owner/ Lessee/Contractor as Ag' nt for Owner
of Contractor License Holder
STATE OF FLOQ_� I , ' n `n i
STATE OF FLORID
COUNTY OF Q_:�S�t" • I�l(i�
COUNTY OF
The o�'jnstru knowledge�l( fore me
this�__(_1dayof ' 20 I `�by
The fc�70rumeTas cki owledg0efore me
this I 20 by�
►
�alo_4�-e -e l I
Name of pets aking statement
Name of n making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type Identifi
Type of Ide tiff a i �+� I/ ry�
i
of t• n
ProducedC�
Produced'., (J°-x� Ll�1l.�
(Si na' of Notapilu Igy��ate of F a
(Si na re of Notary P blic- State of Florida )
`��FER C09�'i: Seal
Co issi n� :�tissioro S_ �, ( )
C mis ion No. ���`\\\�FEIR11C/����� Seal).
)
30 IO
NOTARY
REVIEWS,
��RM:ZO11NG.-SUPERVISOR
PLANS
VEGA7JRNPUB�ETTURTL(��'
MANGROVE
�tO�IEW,
REVIEW
REVIEW
REAEE•.&,
RE V1l
REVIEW
DATE RECEIVED
OFiF' �`\�
Fl�pP�•\\
DATE',
iuni
COMPLETED
Rev. 8/2/17