HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T//1/ Permit Number: l V V oo7.,
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
SCANNED
BY
St Lucie Counfy
Building Permit Applicati
RECEIVED
n MAY 012018
ST. Lucie County, Permitting
Commercial Residential -1""
PERMIT APPLICATION FOR: A6 �' 140446welvi"4-
Address: 10PO
Legal Description: /dtiL
Property Tax ID #:,�IlYd ^ 5-0 Z — D 07_7
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: ! Left Side:
Lot No. YY
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator �oof
Total Sq. Ft of Construction: I Sq. Ft. of First Floor:
Cost of Cons I+ruc ion. `-hp //Uy Utilities: _ Sewer _ Septic Building Height:
OWNER/LE-86S@I :
C«ONTRACTOR:
Name
Address: 11/711 �lr`L�/i��
Name:
Company:
Address:
City: Pg_�wG-C, State:�c
Zip Code: 'J Fax:
Phone No.��%- c/Go� lrZ9�
City: State:
Zip Code: Fax:
Phone No
E-Mail: /%1�Q�7✓e -/!off ��i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR+UCTION LI aN L.AW )'NFORMATION:
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
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
which is in conflict with any applicable Home Owners Association rules, bylaws that
or and covenants 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-werIcTyr-Fe,cording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor�as Agent for Owner
i
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledge, before me
The forgoing.instrument was acknowledged before me
this day of (�By 20J 1 by
this day of 20_ by
W PAS
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
/
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identifica '
Type of Identification
Produced
Produced
Commission No. KAREP`1
morissi� No. (Seal)
Commission #
FF�L 66N7
9j�on°•.��
Junta 2�
on Expires
2
REVIEWS
FRONT
ZON
—
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV E '
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
�ev./2014