HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSII APPLICABLE INFO I� UST BE COMP L, LD FOR APPLICATION TO BE ACCEPTED
Date: I �• Permit Number:
i SCANNED
9 BY Ludecmft IVED
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Building Permit Applic tion AUG 0 3 2018
Planning and Develop 'dent Services
Building and Code Reg ation Division
Permitting Departm.eat
300 Virginia Avenue, rt Pierce FL 34982
Phone: (772) 462-15 Fax: (772) 462-1578 Commercial R sick�t�af d! I' y, F ,
ERMI I APPLICA'jION FOR: 01,;K76t&, rT .
A dress: I T
i
i Le al Description:
I �I
Pr perty T Ix ID #: ® c� Lot No.
Sit Plan Name: I Block No.
� I
i
Pr ject Name: '
Se backs Front Back: Right Side: Left Side:
' � ETA FLED DE R TION C} � R�K:
STRUCTinN I FO TION:
bona w' ork to be p I""",n,
rrne un er t is permit- check a t at app y:
Mocha ical Gas Tank _ Gas Piping t'" _ Shutters _ Windows/Doors
_ f
_ ElectriPlumbing — Sprinklers - Generator _ Roof Pitch
Sq. Ft of ConstructSq: Ft: of Fi6t Floor:
of Construction: $d lz� Utilities: •Sewer _Septic Building Height:
a1t11NER%l.LSEE•
«• TRA O
Na a �—'
Name: Y ,!2-M,
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Company: / T!� /r�,'
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Ad ress: lil _ a
Cit e I Stater;
Address:
Zip Code: I Fax:
City:
State;,
Ph ne No.
Zip Cody_•
Fax?Q • (L6/ �G S
E- ail:
Phone No-?).) Zzlk/ 2-3,*
Fill n fee sir ple Title Hodder on next page ( if different
E-Mail
fro the Ovner listed a ove)
State or County License%
/ 2.=2d / 6 !;k
If value of construction is 25Qp or more, a RECORDED Notice of Commencement is required.
lJR l.� E C®NSTR
Ci'FC;N LIEN LA I `
�OR�MAit � 111:
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 c.ovena'nts 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.
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STATE OF RI ,�::*�,;,
STATE OF FL I I
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COUNTY OF=
COUNTY OF!M
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The f rgoing instru nt was acknowledge pefor rge ""
The forgoing inst ment was acknowledged befor
rye
this day of 20 by rt,
this day o 20by
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a e of person makin stafement. o �'
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of person making statement.
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a s =
Versonally
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Personally Kno%, OR Produced Identific i. °'�
Known �OR Produced Identific
§ �� m
Type of Identification
Type of Identification I
oN
Produced a
Produced
(Signature of I#ary Public- State of Florida)
(Signature of Otary Public -.State of Flori a)
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEAITURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
RF�NIE.W
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17