HomeMy WebLinkAboutBUILDIING PERMIT APPLICATIONAll AP P ICABLE INFO MUST BE COMPLEI.'__ %k APPLICATION TO BE ACCEPTED
Permit Number:
Date: i
SCANNED
6Y
.� IVEDBuilding Permit. AppliFRECCE
A9G 0 7 2018Planntand Development Services
euildin and Code Regulation Division cle OUM PeP►itlEi;TO
2300 into Avenue, Fort Pierce FL 34982
Phon i (772) 462-1553 Fax: (772) 462-1578 Commercial Residential i(
PERIV}IT APPLICATION FOR: 4,A-e r', %%,r r w N t%;e
Address I 1A O ��, Tc ��, fr. �S � -e 1 ar1 .�,'erG t..144 SYY Z
Legal DE I�cription:
Propert4 Tax ID #: 3 V C'7 _- V 5 ( —000 [ —Cr j O -
Site Pla Name:
Project ame: �i. ,c r
Front Back: o Right Side: Left Side:.
Lot No. I
Block No. �2.Z
i .m l /, / / / ,:. , zi_r. �'i _ .' �i /n r% /mot C n.s iA �_ /i r_ .� r �i d �% �/ K /i� �P N eYr: L
II
N5 UCTI ¢ N NFCI MAT10
AdditionV work t0 be Derformed under this Dermlt —check all that aDo v:
Mel hanical Gas Tank Gas Piping —Shutters_. ._ _— Windows/Doors-
YEI ric — Plumbing _ Sprinklers — Generator; .;t; ;Roofs ; ,�„ <: Pitch
{ . —
Total Sqti!
of Construction: Sq. Ft. of First Floor:
OG
Cost of.struction: $ � D�a Utilities: —Sewer Septic Building Height:
01iVN R/LE�S�S �E:
�C� RACT +R:
Name I'
Address
City:
Zip Cod
Phone
E-Mail:
Fill in fell
from th
�'ma4X sx L/dr^ k-
-Name:
Company:
Address:
/,2d % ��,'�� 064
&" 1",c.- State: FL
II. 3 Y9 $2, Fax1772) i66- 96 //
.� 7 7,2 .3 5- - 093
City: State:
Zip Code: Fax:
Phone No
iT,-m
simple Title Holder on next page (if different
Owner listed above)
I'
E-Mail
State or County License
If value of', onstruction is 2500 or more, a RECORDED Notice of Commencement is required.
7
DESIGNER/ENGINEER: 4L 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:
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as iInidicated. .
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 reitording your Notice of Commencement.
Sign ure of Ow ess a/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI 4A r
COUNTY OF Sft OT LU-0 E
STATE OF FLORIDA
COUNTY OF
I
The forgoing instruent was a knowledged before me
The forgoing instrument was acknowledged before me
this —2— day of /-1y.� US 20 N by
this day of 20_ by
(Name of n ac1SA1J cJSi�0 _
(Name of person acknowledging)
.
My COMMISSION # GG079649
EXPIRES March 06, 2021
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced .
Produced
Commission No.&G 07 6, (Seal)
Commission No. (Seal)
REVIEWS I
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
j
DATE
COMPLETED
'
eV. 7/2-014