HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE LuMPLETED F, vft APPLICATION TO BE ACCEF -i rJ f Q
Date: SCANN D Permit Number: ! '005� 039s
B1(
Cycle ftnfv
' RECEIVED
1 Buil ing Permit Application MAY M 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,.Fort Pierce FL 34982 St. Lucle 9ounty
Phone: (772) 462-1553 Fax: (772) 462-1578 C , mmercial Residential a/
PERMIT APPLICATION FOR:
PROPOSED UNPROUEMEN L(+7CATIC+3N;
Address,zMo-j -rY0W10VZCkA Rooms Foy- 1>t,eYCe s✓D• 3(461(4S
Legal Description:
Property Tax -ID #: aol 15 ^ LI:JS-\'00O3 a0 - L4 Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I
t
-r00 +S 6 s -Y 4 Q
l�
I
7[C=0@N-STRXrC"T1I'@]N 10N.-N MA ll-W
itiona wor to a pe orme under this perm t - check a that app y:
_Mechanical _ Gas Tank _ G s Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ S rinklers _ Generator 'Roof PitEh
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
s o Coustion: 1»�, Utities: —Sewer _Septic Building Height:
OWNER/LEWSSEE:
CONTRACTOR:
Name: V)ty"
Company:
-Namew.'11�&M I G.C'"'roko.
Address: 2%o-1 iron =i6v� q e p. •
City: 'f or+ 'Re-fC.e State: I•
Address:
City: State:
Zip Code: alctgl ; Fax: I
Phone No. ` -761 -310-h04 �
Zip Code: Fax:
E-Mail: �cve cud 1� /
Phone No
E-Mail
Fill in fee'simple Title Holder on next page ( if ifferent
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDEQ Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable,
Name:
Address:
City: State:
Zip: 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 clothe 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 Hoene 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 ap roved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building p rmit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, imming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO O NER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements o your property. A Notice of Commencement must be recorded and posted on the jobsite
before the fir inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _Z6AIX�
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this k A day of iDg" 20_13 by
this day of 20_ by
(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 Identification
Type of Identification
Produced - — --
` 'HAHNA INGI
Produced
�`�: Notary Public State of Florida
Commission No. = `� 4 My Co��rS .ZL .pires Dec 20, 2018 ,
Commission No. (Seal)
x
Commission # FF 177299
OFFNotaryAssn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
-
DATE
COMPLETED
Rev. 7/203.4