HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE.COMPLi rD FOR APPLICATION TO BE ACCEPTED
Datl :b ) Permit !Number: /� V 6 —y
SCANNED
BY RECEIVED
Pldnning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
PkIone: (772) 462-1553 Fax: (772) 462-1578
it
PERMIT APPLICATION FOR:
ress: O
it Description:
St. Ladle L;OUNY
Building Permit ApplicLen
N 2 9 2018
Permitting D partment
i unty, FL
Cr', nercial R
N'
3a1-go-?-0o5a000a
Lot No._
Plan Name: Block No.
ect Name:
bpl,k- Front Back: Right Side: A/gZ .4 Left Side:
Cm
ditional worK to De perTormed under
_Mechanical _ Gas Tank
permit — check -all ,that apply:
Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
al Sq. Ft of Construction:
It of Construction: $ 42/ OD 0, 0 Q
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
QWNERjLE-�S�SEE
CfJNTRACTOR;
it NameVihcevii morece• ho 0
Name:
Address: 6-b /y WA-WA-0 l p+
Company:
City: o(t- -S . L-w Cl P Stater
Zip Code: q Fax:
Phone N.o. C,
E-Mail• �28V1 fl ✓i15 s' S�:✓►')
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
suP . R N t c ST rUN L ru t.AW I
FOR iION;
DESIGN R ENGINEER: ,Not Applicable
Name: EMAK0 5' I ram, -J,
MORTGAGE COMPANY: _ Not Applicable,
'Name:
Address: -70 Wt10 v1-
City:/11►vts State•
Zip: Phone ,9 I. ft 9 1 3 91-9 —
;Address:
City; State:
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, ['do hereby agree that I will, in all respects, perform the worki
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 "M
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 our Notice of Commencement.
SignaHtresoff0`.ti:0?4Lessee/Contractor as Agent for Own
ature of Contractor/License Holder
STATE OF FLORI
TE OF FLORIDA
COUNTY OF
UNTY OF
The r oing instru n as acknowledged efore me
°O N
forgoing instrument was ack wledged before me
"tla
thiday of 20 by
s
Y I day of 20 b
— Y
n r rn ng
Name of person making statement.
a of pers/makitatement.
Personally Known OR Produced Identification
Wally KnOR Produced Identification
Type of Identification ,;fv
•• of Ident
Produced
ced
(Signature of Nol§N Public- State of Florida V
(Signature Notary Public- State Florida
of of )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
/
RECEIVED
DATE
COMPLETED
Rev. 8/2/17 1 . 1Y