HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONN
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ALL APPLICABLE INFO MUST
BE COMPLETED �FOOR",PFPLVJ&ATION TO BE ACCEPTED c
Date: ' 4v' % by Permit Number: � � 0 toRon
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Building Permit Applicati
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
JUN202018
Permitting Department
ReMd"WP C nty, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at.the end of line
Address:
Legal Description:
Property Tax ID #: _� �' 2.�j • �i
Site Plan Name: r
Project Name: C ko-e-L1 `tn
Setbacks Front_ Back;
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'E;y LED D"9W_4AIPTI'ON'OF '.` ORK::
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Right Side: 10 Left Side: A) f -
oP 14ome- 6onemNnr-
Lot No.
Block No.
CONSRUO,NINF®RM4_ TIO:N;:.
Additional work to EfGasTank
orme under this permit- check all
app y:
LHVAC ❑Gas Piping In _Shutters n Windows/ Doors
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Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: . Ft. of First Floor:
Ir.
Cost of Construction: $ . 41* ' _ ° n Utilities: Sewer E]Septic Building Height:
c3�WN,E�RYLIS�SE=E�I. CQNT.RACTOR'
Name''�r,cn. Ckcr-L
Address: 306(
City: State:
Zip Code:-2>9gg0 Fax:
Phone No.-1'7)_-qA& - 8 Lt3
E-Mail: A I1A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: C�_5- NQorc
Company: G_S Mere. Cleck-C'C_
Address: _IRI S( lAcirler Mr
City: _yC'f oPc�C i,� State:
Zip Code: 3�Lg6CU Fax:-'via72y-Zg3q
Phone No.-11D---1 - 6\ 3
E-Mail: _c.1GG&-N 0 r'cmca* s f , ne\,
State or County License: E C_k3m(,1 g: �t_
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�� SAU.P. LEM,, .ENiALCO.NSTR+U SryI�YNfI'E.N LAtW I!N"F'ORiMA ;;I
Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _✓ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:. Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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
commencing work or recording your Notice of Commencement.
Signature of OwAr/ Lessee/Contractor as Agent for Owner
STATE OF FLORI A
COUNTY OF s d 4n PNv cr C-o u
The foing instrum t was acknowledged before me
[g
this ��-1 day of , IJ^n e... -)n 1 (Y h.,
�- .
Name of pdyson making statement
Personally Known OR Produced Identification
Type of Identification
Signature of Notary P e grida) �
.;.
Commission No. F1 Seal) a �s
REVIEWS I FRONT ZONING
COUNTER I REVIEW I S REVIEWOR
COMPLETED
Rev. 8/2/17
Signature of ontractor/License Holder
STATE OF FLORI A ,
COUNTY OF -- \ &n P\�r Sp b1' g
The f going instrum t was acknowledged before me
this day of 'Q. 20A<:� by
a v S. M <3-3 ce-
Name f pewrss n making statement
Personally Known � OR Produced Identification
Type of Identification
ProducedE FL it MMEA
n
(Signature of Notary Public- S ids a of Florida -Notary I
%' '' •= Commission # GG 141
Commission NOS] �Q;�o�no"°(�y��yo mmission Expi
"'`� �""sA'dtembef 09. 2n2
PLANS I
REVIEW V EGETATIEV EWON I SEATURTEV EWLE I MREVIEWVE