HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAP �ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1 MANNED
Date: Permit Number:
BY
- St, II_uds (Gbumy KIM C. EIS
Building. Permit Application. AUG 0 3 2018
Planni and Development Services.
euildin and Code Regulation Division Permitting D e � �' trn e n t
2300 rginia Avenue, Fort Pierce FL 34982 t. ' 9 C i U t 1 t r I- L
Phony (772) 462-1553 Fax: (772) 462-1578 Commercial _..._..-._,. R
PER 4IIT APPLICATION FOR: To Select from dropbox, click -arrow at the end of line
PROPOSED SED IMPROVEMENT LOCATION:
I Addres�'I: W
Legal Description:.,Qf!/
0,
Prope Tax ID #: 3�/ 1 7 I / - 5q4' - O,30- GOB Lot No.
Site PI n Name: Block No. _ S-
Proje Name: D4/r!�i/ et,(-3
/
Setba ks Front Back: Right Side: Left Side:
DEVILED DESCRIPTION OF WORK:
/h
�. ;II7�-�� /"ter ,�h�'' S�"/� L1�i�✓% /� r�'!
CON$TRUCTION INFORMATION:
Additional workto be ne orme under this permit -check a apply:
r1HVAC L=1 Gas Tank ❑Gas Piping _Shutters nWindoWs/Dbors
Chlectric D Plumbing []Sprinklers Generator _Roof Roof pitch
Total; q. Ft of Construction: �2'7% S '. Ft. cif First Floor: —7;
Cost' fConstruction: $ �/$D�"�QO' Utilities: LJSewer-'Septic Building, Height:
1
OW'N
ER/LESSEE:
CONTRACTOR:
Nam11
g tr L Ir/
Name: C 6zF�<S
Adr
10 se t!'i4�' C
Company: /-0S la f of
CitFr
Address�•341� s'�' 7S WZ
S1 •� L'ie-1 State:
Ziode4sz
Fax:
City: P ft state
Ph
Zip Code: 3f 7 G Fax:
No.�7zFille
E-Mail: O c ir.9,�- /oo Hg �; 6fror
E-_.Phone
Title Holder on next page ( if different
listed above)
State or County License: Ce C Cr_3 5'G?
of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
SUPPLEMENTAL
CONSTRUCTION11E LAW INFORMATION:
DESIG
Name
Addre
City:
Zip:
ER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:.
Address:
-City: State:
Zip: Phone:
s:
-State:
7Phone
FEE S
Nam
Addr
City:
Zip:
'MPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name: `
Address:
City:
s:
Phone:
Zip: Phone:
OWNE / CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi hat no work or installation has commenced prior to the issuance of a permit.
St. Luci lCounty makes no representation that is granting a permit will authorize the permit holder to build the.subject structure.
which' in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structu e. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consi eration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the work
in acco (Idance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follwing building permit applications are exempt from undergoing a full concurrency review: room additions,
_ actess III structures; swimming pools, fences, walls, signs, screen rooms and accessory uses to anothernon-residential use
Wn1A o ING TO OWNER:.Your failure -to Record.a.Notice_o# Commencement_may.tesult-in.your paying twice for
p ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor a the st inspection: If you intendto obtain financing; consu/!t with lerider or an attorne fore
��m rin[r i �nrlr nriF�rnrrlin6 vAHF1�At1/`P Af rArYI ITIPr1!'PrTlPtlf•/ / /J /1
i
Signa#u Owner/ essee/ ontractor as Agent for Owner
ignature of ractor/License Aolder
STA OF FLORIDA
L�
STATE OF FLORIDA_
CO OF S/�N� z t�
COUNTY OF
was ed before me
The rgorng itrument a acknowledged
nsg
The forgoing instrument was acknowledged before me
this day of , 20_ by
this day of 020 by
r/ �i
��r - �os>�i�r�a� ce r
Name of person� ing statement
Name of person makin tement
Persil
pally Knowny OR Produced Identification
Personally Known 2/bR Produced Identification
Typ
of Identification
Type of Identification
Pro
ced
Produced
(Sig'
ature of Notary Publi - a
(Signature of Notary i�
RICKY CARL COCHRAN
':
�;�+,' •.,• RICKY CARL CODftlaryPasm
Co
«"Y ; - State of Florida
ission No._--•., -..-. -:' : Notary[&M� y
=: Notary Public
Commission No.-,.___-_ .a_ +.. + =
Commissibtt�
• = Commission # GG 172136
• . =
My Comm. Expires Apr 26, 2022
.
`z?� + uY' My Comm. Expires A
'
+ ;, • Bonded through National NolaryAssn•
.� w r4� Bonded through National
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VIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE-
MANGROVE
1
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DA
RE�IEIV-ED.
E
DATE
COMPLETED
Rev.