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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLF INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED \ Date:EiA 19, Permit Number: 1J6 C) SNNED RECEIVED �1COU11� MAY 2 3 2018 BUiIcTing ermit Application Planning and Development Services I ST. Lucie County, Permitting Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce F134982 Phone: (772) 462-1553 Fax: (772) 462-1578 j Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lines .PROP,OSEOl MPROVEM ENT LO.CATI,O;N . Address: q 416 1� I O Legal Description: Property Tax ID #: —�` �U=✓ ` `� Lot No. Site Plan Name: I Block No. Project Name: Setbacks Front Back: I Right Side: Left Side: I DEI"AILEp'-DESCR_IFTIONIOF VIIO.RK: -1:y1s+a i qo I n (!�Yts A no-1 `CQNSTRUCTIQ.NiINFORIVIQTLON_:- Additional wor to be nertormed under t'is permit —check all that apply: E1HVAC Gas Tank Gas Piping _Shutters Windows/Doors L1Electric Plumbing Sprinklers E]Generator Roof Roof pitch Total Sq. Ft of Construction: I S 11 Ft. of First Floor: Cost of Construction: $ Utilities: _Sewer Septic Building Height: : O.WNER%L.ESS-EE:- CONTRACTOR:, Name 'i l Address: I n City State. Zip Code:3��LL Fax7lia-31� _" Phone No. — - Name: Blake Cowdell Company: Energized Gas Address: 4252 Bandy Blvd.. • l Fort Pierce State: FL City: ' •,� e:34981 Fax: 772-318-6672 one o.772-466-1095 E-M ' . E-Mail 1 Fill in ee 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 requires. ; 5UPPL_EMENTAL CONSTRUCTI L�'N11,11t i LAW I�NF©RIVIA�TION ' DESIGNER/ENGINEER:-' " Not Applicable MORTGAGE COMPANY: Not.Applicable Name: ! "Nam �'' • o,Cowdell - Address: Adless: City: State: ;.; r; ; 4ity >;s ? State: Zip: Phone Zlp. ""` Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: 4252 Bandy Blvd. 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 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 commencing work or� recordingour Notice of Commencement. ' 6w &a &Ah� ckw� Signature of Owner/ Lessee/Contractor as Agent for Owner — Signature of Contractor/License Holder STATE OF FLORIq��1I t rIn COUNTY OF - STATE OF FLORID&I , 1 , n cam+' l -e_� c I COUNTY OF �_— The ng lnstr nt wa acknowledg before me this lay of I�l 20 by The fforg 'ng instrun en$ as acknowledgf#before me this [�' day of ,�'` 201 Q% by -001be Name of pers n making statement Personally Known _G OR Produced Identification Name of peW n making statement Personally Known /1., OR Produced Identification Type of Id e t' ic,a io I ^/� ,� r ! �V lAJn Type of Identification Produced l�.J Produced (Si nature of Notary Public- State of Florida) ( gC.n ture of NotaryPublic- State of Florida ) Commission No. (Seal) Commission N \p����rrr (Seal)' \`��►nliiurrrrii ��. REVIEWS ,,.� •,Miss _F�2Qf��°so o;�, P '�% . o�E3 d51Cr SUPERVISOR PLANS p:VEGE ry o rA &.r 'fl�3i� NEAIURTLE: "!'MANGROVECOL�VIIERTA tl REVIEW, REVIEW 6�VWIc '•RE&IE* ''• REVIEW DATE RECEIVED p n U BL PUBLIC = c l • > . a,. F , .� o , DATE '%,��y' !�l #GG y61•''Q �.�� ��ryrliIi1111\0 COMPLETED Rev.8/2/17