HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��=z /$l i ANINIP Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-
SC
BY RECEIVED
: t Lucie County
gilding Permit Application APR 2 6 2018
IST, Lucie County, Permitting
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROP05ED IIVIPROVEiV1ENT,LOCATION . ;•'.
Address: 3/ SA"V-1 L�9Nr°
Legal Description: �i inf ,,
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Property Tax ID #: �`7 l �% ��� - o 0 6 - as Lot No.
Site Plan Name: Block No.
Project Name: ��� C/r�c4aws/Zi
Setbacks Front Back: ,, Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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GONSTtUCTION-INFORMATION
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11HVAC U Gas Tank ❑GasiPiping 1J Shutters a Wind/Doors
Electric 0 Plumbing Sprinklers E Generator Roof 3 Roof pitch
Total Sq. Ft of Construction: Q / JCL' S . Ft. of First Floor: 7 a/-
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Cost of Construction: Utilities: Sewer E:l Septic Building Height: 14 —3
OWNER/LESSEE..•:
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CONTRACTOR:;
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Name' : �
Address: r,,
City: State:/
Name: ('s�c G%s o% .•
Company:,4,,-,,y
Address: 3�12S a>;✓�-
Zip Code: 3 Fax:
City: Irl_ Stater
Phone No. Z 9 %/
Zip Code: 33'-i io Fax:
E-Mail _
Phone No. 77 2 26a-S7S�
Fill in fee simple Title Holder on next page (if different
E-Mail: Coc n,�2 6i S ~,¢, / c-,,"
from the Owner listed above)
State or County License: (f C C G?P�Sa 7
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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°5UPjjPLEI�IiENiAL,CONSTRU,GTION]Li}LAW,INFORVIAT101,I"
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
I
Zip: T Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone: I
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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.
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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 1 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 attornev before
commen,ckv--work or recording vour Notice of Commencement. _--) /l
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essee ner--�
Signature of Own;lDt;��/
Signature o ractor/License Holder
STATE OF FLO
STATE OF FLORI ACOUNTYOF 2�
•�
COUNTY OF A�
The for oing instrument was acknowledged before me
ar
The for oing instrument was acknowledgedbefore me
0y
this day of �SIP� , 20ZZ by
this day of 4PI 2t by
Name of person maki statement
Name of person g statement
Personally Known R Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification.
Produced �gCHRAN
Produced
RIC
otary public -Staled Florida
Commission i es Apr 26,I2022
m• xP
RICKYCARLCOCHRAN,da
nr
Signature of ! „ lic of a �"
(Signature of Not ` taN@tm (SG 172136
�{t� ' • = r 26, 2022
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Commission No. (Seal)
Commission No. P.,
....
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN$
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17