HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
II APPLICABLE INFO MUST BE COrMPLETED FOR APPLICATION TO BE ACCEPTED Ci
Date: �� �[ a d"OIS/" Permit Number: �-�-0
SCANNED RE` E I V 'Em [w)
BY
St. WOP� , COUtI- JUN $ 7 2018
_ Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
�,I PERMIT APPLICATION FOR: ,c
ress: 3 3 L 3 c1
iI Description:
td-u 4, l
P' operty Tax ID #:
Si, a Plan Name:
P �,oject.Name:
S�tbacks Front Back:
M
rz
Permitting Department
/ St. Lucie County, FL
Commercial V Residential
aJ
AO) 4-
Right Side: ,.Left Side:
Lot No.
Block No.
N
Adlitionai,worK:to be pertormed under trus permit;- cnecK aii tnat apply: .
Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator oof// Pitch
Tot' I Sq. Ft of Construction: 3y U C2 Sq. Ft. of First Floor: 30
Cos; of Construction: 06 Utilities: _ Sewer _ Septic , Building Height:. /O
N6I e
li fG
Name: O
Ad ress:
Citl :
Zi Code:
Ph', ne No..
A,C22
State: ,Z2�^_
Fax:p
- i? 63'�d / U�
Company:
Address: r, (f ,4�
City:Stater
Zip Code: 3y C1 — Fax:
Phone No
E-ail:
FilllLn fee simple Title Holder on next page ( if different
fro the Owner listed above)
E-Mail a
State or County License C - (- C 7?,JL4
If valije of construction is 2500 or more, a RECORDED Notice of Commencement is required.
�lJ'P ' l.E' E TAL CANS R�UCTI � I � �FC>~R
ATION
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 non-residential use j
WARNING TO OWNER: Your failure to Record
a Notice of Commencement may result in our paying
your
4
improvements to your property. A Notice o
cement must be recorded and d ongt
before the first in ion. If you intend to
t�: ncing, consult with lender or an attorney b'
commencin ork or cordin our Notice
encement.
m
i�
5
2
r- MST
1.
ssee/Contractor as Agent f a
SignatrFLORIDAZ,�,.,e
Signatu r o icense Holder 0' _
m9
STATma=STATE
C �T
O LORIDCOLI=a$
COLIN OFThe
3�1
font was acknowledged before ��
The f going in t was acknowledged f
this day of 20 / ii9by a "'
this o 20. %y 1I
(7 -
Ohl T' � ni Y 'PRO Jlr-7%FT- --
Name of person 4aking statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known -� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Nq64y Public- State of Florida )
(Signature of NotPublic- State of Florida)
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17