HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �J
Date: k Q' J,,D1 U SCANNED Permit Number: /.i
BY
St. Lucie County RECEIVED
Building Permit Application JUN 2 5 2018
Planning and Development Services
Building and Code Regulation Division ffi, Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT . • FOR:
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Address: a b
Property Tax ID #:a - O Lot No.�
Site Plan Name: M Af Nr a` _
Project Name: _KJL.0n !:.-s
Setbacks Front Back: Right Side: Left Side:
Block No. Is
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QWindows/Doors
Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ J4 00 obn , d V> Utilities: _ Sewer 0 Septic Building Height: / S
Name X-Ce-A +-
Address: atoei MAC \i> .
City: '� -� r,-?IL State: 1 -
Zip Code: 'H Cl ',-I 9 Fax:
Phone No. 339 310 ,-„1-1Lt l7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
Name: O CA-il
Company'__�o o 4
Address:a,55D SE rc L, e, e, .
Cito,�� _ tom. cif State: .
Zip Code: -'-+-t e15 "ZiL_ Fax:
Phone No.
E-Mail:
from the Owner listed above) State or County License: CC.C. 1 b a Xt to
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_2C Not Applicable
MORTGAGE COMPANY: )o 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:
City:
Address:
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
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Sig ture of Owner/ essee/Co actor as Agent for Owner Sig"ature of Contractor License older
STATE OF FLORIDA U. STATE OF FLORIDA /
COUNTY OF )�- LU !.� COUNTY OF
The for oing instrument was acknowledged before me
this s� day of 20A by
Le cs
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
The forming instrument was acknowledged efore me
this `�J day of _i/ 1 201 X by
6 /,,// &' -) Z_"_ 4-S 6L S �/)
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signaore of Notary Public- State of Florida) (Signy Pure of Notary Public- State of Florida
rr MARKKENNY
Commi`w.,��1,�gg (S Commis, MARKKENNY ( eal)
w Q Expires September 19, 2021
':,� commission# 1. 9
Bonded Th. Budget Notary ser i= , Q Expires September 19, 2021
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER I REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
COMPLETED
Rev. 8/2/17