HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED
Date:
APPLICATION TO BE ACCEPTED
Permit Number:
SCANNED
By
Luce CounW
wilding Permit Appl
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
M& am It IMM
REU:1Vt:D
tion MAY 0' 8 2018
.Permitting Department
St. Lucie Wunty, FL
PERMIT APPLICATION FOR: ycayzl_ fir- ' L
Xi 4---tv-
PRapC3SED
IN.RROUEMEIVT lC3CATIQiV t; ., .
Address: zaz> 6kA ' IDft V(e(« 1
Legal Description: eo�Salos' VD
Property Tax ID #: 1 k* _50*0- 602n 6no—o Lot NO—VI3 zsr�
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
nc==n �ucm nc:cristr
Aaoitiona,i worK to De perrormea unaer tnis pern
_ _Mechanical _ Gas Tank _ G
Electric _ Plumbing _
Total Sq. Ft of Construction:
Cost of Construction: $ k o j 000d Old
— cheMall that apply:
Piping ', —Shutters
inklers _ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Name C.CAVeAV
Address:Z Avetwe
City: State: TU
Zip Code: I%Ct %A& Fax:
Phone No. 777--465', 038-7
E-Mail: I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Windows/Doors
Roof re... Pitch
6
Building Height: �0
City: - State:
Zip Code: Fax:777r7--tSS�ct
Phone No
E-Mail
State or County LicenseelE oSM�( �
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name:,
C'ify. - .. Stater
Zip: Phone
FEE SIMPLE TITLE HOLDER: �C Not Applicable
Address: � r I
City: -
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
.City: State:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: .Phone:
Applicable
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.O.wners 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 agreethatl 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. /
4odwrie'r/.
Sig e Lessee/Contractor as Agent fo Re r ,,.=
Signatur ontractor/License Holder
STATE OF FLORID ' I �
STATE OF FLORIDA
fig.
COUNTY OF GiGLe- T t
COUNTY OF �C d%`
2 � 9
rn
The for oing instrument was acknowledged befog eN F
The for ing instrument was acknowledged before
�Vi
$
this day of 20' byg
this day of 20 by
I/ `. )v\ -3 IVhe
(N me f person acknowledging)
(Name o pe on acknowledging)
(Signature of Ootary Public- State of FI rida)
(Signature of 6dtary Public- State of Florida )
FOR
Personally Known OR Produced Identification
Personally. Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission.No.; (Sea.l)•i`.
Commission No. (Seal)
REVIEWS
FRONT
ZONING,
SUPERVISOR
PLANS
VEGETATION-,
SEAT,URTLE.
%MANGROVE.
COUNTER
REVIEW `
REVIEW
REVIEW
REVIEW
REVIEW '
REVIEW
DATE
RECEIVED
DATE
COMPLETED'
Rev. 7/2014