HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
SCANNED
BY
•► St. Lucie County per ��N ` ' �
mi?Ol®
• r St ft. .
Building Permit Application cUce p�pang
Planning and Development Services County ent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT OPLICATION FOR:
Commercial Residential
Address: /3 7K.� i✓j i 7 Re�'C £.. /`"L • , J� �� �f G
Legal Descriptipn: f tdc/tJ/c -J 1Mo✓' ZL-\\ 4Z LoT 5 6oR g10�f
I
Property Tax I i #: / 9 a$ 70,3003 7 D0O I Lot No. J
Site Plan Name. Blor? qi/
Project Name:
Setbacks Frbnt Back: Right Side: Left Side:
wio �� 't V\��&a at, 1Z` a V,,� Z,v Lf V-) CCAU; 9, eI4-e,-Gd 1T,eJ as p —TI �l
Additional work to be pertormed under this permit— check all that apply:
—Mecha 11cal — Gas Tank — Gas Piping — Shutters indows/Doors
Electric Plumbing _ Sprinklers Generator Roof Pitch
Total Sq. Ft ofj Construction:: Sq. Ft. of First Floor:
Cost of Construction: $ % O0� Utilities: —Sewer _Septic Building Height:
OWNER) E�S-SEE:
60 l"RACTOR•
Name ��niS o...n�an�0. 1--HQwA
Name:,.,:,,
Company:
Address: -
AddressU : ` 300 tCO Sf 4.of /W3
City: g-o ���-c� State: L
�Jp—
City: . State:
Zip Code: 3 2 9 ` Fax:
Phone No. II 77A Z 7 7079'1
Zip Code: Fax:
E-M a i l :(ZnD &,y 4@
Phone No
E-Mail
Fill in fee silmple 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.
RO,Q:.EMENTAI, eo Sl'R� �oN E.I; � uv IUF+oR,
A`TlON
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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'hon-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.
re of Owner/ Lessee/Contr or s Agent for Owner
Signature.of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 201$ by
this day of 20_ by
Name of erson making statement.
Name of person making statement.
Personally Known OR Produced Identification �'
Personally Known OR.Produced Identification
Type of Identification
Type of Identification
Produced 1—�.h:
Produced
na ure of Notary Floridla9yAHNA INGRAM
(Signature of Notary Public- State of FloridaS
Notar Publlc - State of Florida
IM
M Cay
Commission No. , f �� Peres Dec 20, 2018
Co Inesi0 n # FF 177249
Commission No. (Seal)
Bonded through National Not
Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2117