HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLIC BLE• INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: II I C� ! SCANNED Permit Number:
l BY
St. Lucie County IVED
RECEml ;
Planning and Development Services
Buildingl and Code Regulation Division
2300 V' g►nia Avenue, Fort Pierce FL 34982
Phone�(772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Building Permit Appli
Commercial
cal ion JUL 1 1 2018
Permitting DeOrtment
St. Lucie -ounty, FL
Residential.,,,;
C"-?C9) i 4 0 r). % r C-0(r
Addre s. rr /`/' ,� 1
Legal Iescription: 2 J 6144 ' �1,� Uy?��
I 91,2
Prop rtyTax ID #: Lot No.
Site P'an Name: Block No.
Proj ct Name:
Set I cks Front Back: Right Side: Left Side:
'V-'--�v a V'Oom, '•
-��
-cam
" r,^ 2_x•L_--_Vt no -ram A c-n f-
Yl V-va l i
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Aciditional work to be performed under tnis permit - cneck.all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters _ Windows/Doorsl
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Ritch
otal Sq. Ft of Construction: Sq. Ft. of First Floor: I
(lost of Construction: $ T/ Utilities: —Sewer —Septic Building Height: Ii
OINNER/X7&S E:
CONTRACTOR:
Name ril ZcabPI-,t -7 3Ct
Address: aXa C cs 6�t�
-1
Q
Name:
Company:
Address:
City:bi �rC�
Zip Code: `)4g-23 I Fax:
Phone No. S� / 0-13 3�50
Stater-�
City: State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail: e)a7a(2 -►,r
Fill in fee simple Title Holder on next page
from the Owner listed above)
6 I Co r'
( if different''
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LUEN LAW INFORIUTATION:
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
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 cement.
N
gnat e-ofOwne Lessee/Contractor as Agent for
I
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF
2
COUNTY OF
9
The forgoing instr was acknowledge before r
e ccThe
forgoing instrument was acknowledged before me
this day of 20' by
this day of 20_ by
(Name o person acknowledging)
(Name of person acknowledging) I
I'
(Signature of Nota01ublic- State of Florida)
(Signature of Notary Public- State.of Florida )
_ /
Personally Kno OR Produced Identification v
Personally Known OR Produced Identification
Type of Identification
�C
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
P
EGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
V
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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