HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE, COMPLETED FOR APPLICATION TO BE ACCEPTED �� �d�s
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� i 3 d�$ SCANNED Permit Number. i
Date:
BY RECEIVED
wA m, St Lucie County
' - - APR 3 0 2018
Building Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
34982
2300 Virginia Avenue, Fort Pierce FL
Commercial Residential X
Phone: (772) 462-1553 Fax: (7 i 2) 462-1578
PERMIT APPLICATION FOR To Select from dropbox, click arrow at the end of line Rod:F„rnUA
LOCATION: ` " ,
PROPOSED°IM', ROVEMENT m
Address: JOHN W. OWENS 3740 WHITE DAIRY RD. FORT PIERCE FL. 34947
SEC/17 TOWN/355 RANGE/40E
Legal Description:
2417-234-0001-000-2 Lot No.
Property Tax ID #: i
JOHN OWENSI Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK " n
TEAR OFF OLD NAIL OFF W/8PENNY DRY IN PSU 30 THEN 5V CRIMP
4eC1< o- a
GONSTRU_CTiON"41NFORIVIATION
AdditionalworKto e e ormed un ert ispermit—c ecaappy:
❑Gas Q Windows/Doors
❑_ HVAC Gas Tank Piping _ Shutters
5 12
�
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 42Sp S . Ft. of First Floor:
12000.00 0Septic Height:
Cost of Construction: $ I Utilities:Sewer Building
OWNER/LESSEE: f
CONTRACTOR;
Name O n wens j
Name:
Address:3740 white dairy r i
Company:
Company:
City: —34947 F �State: _
Address:
Zip Code: Fax:: I
City: State:
Phone No. %22-67S-7
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:
If value of construction is $2500 or more, a 'RECORDED Notice of Commencement is required.
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AL CONSTRUCTION LIEN LAW INF,M.� � ,r ,�,�,..�.,,y�,..��,d� �,.��.�,,� ,,,� �,� .�t able
INEER. _Not Applicable MORTGAGE COMPANY: _ No ApplicName:
I Address:
State: City: State:
Zip: Phone i Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: I City:
Zip: Phone: Zip: Phone:
I
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 dome 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 pll s, 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
commencln worK ur reGUf urll uur 1-1— u,
aLe—ssee//!o�ntrlactor
Signa ure of Owner/ as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF • A- �-V �Q
COUNTY OF
The forgoing instrument was acknowledges( before me
The forgoing instrument was acknowledged before me
this � � day of C S\ 20 1 by
this _ day of 20_ by
!Zi6A J�t ow-rS
Name of person making statement
Name of person making
statement
Personally Known OR Produced
Identification
Personally Known OR Produced Identification
Type of Identificl U
Type of Identification
Produced ''CC i._-
Produced
^d
-
145¢➢eSC.L
.•••MVP
(Signature of Nota State
t GIVENS
QfyFl�pfjj ION #00022023
nature Si of Notary Public- State of Florida j
(Signature rY
Commission No. ..
EXPIRES: December 16, 202--0
dedVAWPublic U,derwdte,
Commission No. (Seal)
REVIEWS
FRONT
1-ONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
REVIEW
MANGROVE
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17