HomeMy WebLinkAboutBUILDING PERMIT APPLICATION__J
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SGANNED
BY
k�
-� �. , St Lucia County
moww Building Permit Application
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 Residential
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PERMIT APPLICATION FOR:
!I`pR0UNtENT
LCCAII,QN
;PRC7PC?SD
Address: (0 (a S eaa Oct dawke, &q1 _ 3 9,
Legal Description: E Ql. I CAQ& 9 Noc,loo &C To Ivan Z00A t✓51-'6S U(1l F_ Ig%1 GC!Cac l i
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Property Tax ID #: 5 q02 -�� -- 0a9gi -' OOO —S Lot No.
Site Plan Name: Block No.
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Project Name: 1 ST6� Q - She -A
Setbacks Front ' Ri ht Side LeftSide: a0 C t
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Additional work to be pertormed under this permit - ctieck all that app y:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
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Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
��*900
Cost of Construction: $ Utilities: —Sewer —Septic Building Height: _
QIA/NERji.ESSEE:
�CQNT.
RACTQR aa:
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Name (r�be4 Ike.
Name:
Address:. (ola tGBe- C' 4e'
Company:
City: va- P\tU_:Q_ State-L
Address:
Zip Code: 3� r2— Fax: 9qD -'l9 a-00 "/
City: State:
Phone No.
Zip Code: Fax:
E-Mail: r'A�104SG A0L Ci.OM
Phone No
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name: #
Address:
City: of State:
Zip:.4 Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
,MORTGAGE COMPANY:
Name:
Address::,
City:
Zip: Phone:
_ Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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 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 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
cornmen.ring Wqrk or,repq{di 0bX N-otice_-Al];lVommencement. f
_1gna�tur �= .rierJ�Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 15k.
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this -a day of a� 2033 by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced V L L
Produced
(Signature of Notary P blic- State of Flora
(Signature of Notary Public- State of Florida )
M-e DEA1111AMAR1E G�G0J
Commission No.
YCMAI.A1:fiezin 16Commission
No. (Seal)
& DoremIRE Fuoiicor
:.• /M 11 h.otarl
REVIEWS
; T�
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
_
s/�
RECEIVED
l
DATE
COMPLETED
Rev.8/2/17 - \ l/