HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'ZS��7J Permit Nu
By 'Mr-a�� -aft4 E13121VED
all.Lucia cou* JUL 2 5 2018
Building Permit Appl tr0ning r)e t
Planning qnd Development Services par rrlentSt. LLICIC CQlJrlt . FL
Building a d Code Reguiation'Division
2300 Virg(nia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT
IS:ED
APPLICATION FOR:
PRQP
1NPRO�I MENT
OCATC{
Address: Il'tLWO t'dUUM
Legal Des.cription�
Property ax ID#:-1�7iEJ�YJ ���� � Lot No.
Site Plan I ame: Block No. 47
Project Name:
Setbacks) Front Back: Right Side: Left Side:
Additional work to be pertormed under this permit— cnecK all tnat apply:
_Mllchanical _ Gas Tank _ Gas Piping _ Shutters
ElLtric _ Plumbing _ Sprinklers _ Generator
Total S Ft of Construction: ADD Sq. Ft. of First Floor:
Cost of li onstruction: $ 10 AQ i Utilities: —Sewer —Septic
Name
i.
Name:
Address
I
.Cbr 'panytl :
t 4 lti
P
���"!`r State .:V
Cit�i
Addre
11-
Zip�Gode:lll�ia.
7/ Fax. -'f '°''City:"
► \
Phony
No.
Zip
Zip Code: _�
:
E-Mai
Phone No —�
ee simple Title Holder on next page ( if different
Fill in
E-Mail
from the
Owner listed above)
State or Count License
If valuilof construction is 2500 or more, a RECORDED Notice of Commencement is req ed.
--
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
M'N ORTGAGE COMPANY: ot Applicable
Name:
Address:
City: State'!:
Zip: Phone: i'
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.! I�
In consideration of the granting of this requested permit;1 do hereby agree that 1. 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 a.nd 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. /
Signature oiOwner/ Lessee/Contractor as Agent for Owner
STATE, OF FLORIDA
COUNTY OF
The forgoing instLum-enj was acknowledge efore me
this Z� day of 20 y
�n
(Name o person acknowledging)
(Signature o Notary P I' - Statebf Florida )
Personally Known OR Produced Identification
Type of Identification
Produced -
��1,7 SANDY MGM
Commission tVO. alfptafy Public - State al
Commission # FF 17
•,. -�,o.. My Comm. Expires Feb
REVIEWS . FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signhtur&a,i'Contractor/License Holder:.
STATE OF FLORIDA� ,
-COUNTY OF ' C=�' IJiV
The forgoing instrument was acknowledged before me
this 4D day of ` 20-00y
(Name of person ackkn w dging )
(Signature of Notary7OR
Sta of o da )
Personally Known Produced Identification
Tvne_of Identification
fil 15510r11No. ? 1 -'°`PaY Pie` �c9AANNDY CROGHAN
2 • .° Notate+�C = State at, Florida
' commission,* FF 17;7233.
2019 s9 F op°�� Comm. Expires Feb 6, 2019
,F61
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