HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP
Date:
4
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y nnAA`` l
Permit Number: ou i 0 !
SCANNED
s;BY RECEMED
st, Lade coNnw
JUL 1 1018
Building Permit Application
Permitting Department
Planning) and Development Services St. Lucie county
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:l(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER SIT APPLICATION FOR: �_��� D n -
Legal D&ription:
II
Propert Tax ID #:
Site Pla I Name:
Project Name:
— r
Setbac,s Front
Back:
0[2VZ_) - 00
E's-
Right Side: Left Side:
IRK.
1 r 11 . 1/9A 4 1A An o w r- O.O
or 3043 -
Lot No.
Block No.
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I)1AIl CVli 1161-ec . /'TV,!//lJ , A5_I .4 r + YY/,U) c5hr/2aJ'eS (fin
Aaait onai worK to ne perrormea unaer tnis permit— cnecK an tnat appiy:
echanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
lectric _ Plumbing _ Sprinklers _ Generator 'W✓Roof Pitch
Total liq. Ft of Construction: f Sq. Ft. of First Floor: I .
Cost of Construction: $ a 3D 7 Utilities: —Sewer —Septic Building Height:
Na�.eN1a:o ('63o f e,rcp Ca-1 Ae-ron 4- TA.vlen +
Ad ess '71 k� Cj c� , OLt c r`
Cit I e�U ge (ash State:
ZiplI Code: Fax:
Ph¢ne No. ,�,
II
E- a i I: i3O P,-� .ilblKn /0(MAlo-11 L
Fill jn fee simple Title Holder on next page ( if different
fro i'n the Owner listed above)
If val;oe of construction is 2500 or more, a RECORDED Notice of
Name:.filt-T
? Company:
Address:
City: State:
Zip, Code: Fax:
hone No .
E-Mail
State or County License
Commencemerit,is required.
DESIGNER/ENGINEER:
Name:
Address:=
City:
Zip:
Phone
FEE SIMPLE'TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
—Not Applicable
State:
Not Applicable
.MORTGAGE COMPANY: _fit 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.
r nyf-OwJyr%er./ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder?
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 4C rc"-C
COUNTY OF
The forgoing instrument was acknowledged b fore me
The forgoing instrument was acknowledged before me
this__ day of,:SU) w . 20y
this day of 20_ by
`1
( a e of person acknowledging),
(Name of person acknowledging)
(Sig ature of Notary Pub li tate of Florida)
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification ,)e
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
1/1111,
Produced s;
Commission No. (Seal)
9oc
Commission No. (Seal)
N
i
t7 '.
REVIEWS
FRONT
ZONING
h'
PLAN
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
RED/ WT-
REV!
REVIEW
REVIEW
REVIEW',
DATE
RECEIVED
s c C) z 0°
DATE
COMPLETED
O M 00 0 7n
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7(3ttie
Rev. 7/2014
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