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Home My WebLink AboutBUILDING PERMIT APPLICATIONII ALL �I PPLICABLE 111J,F,0 NJ,).1S �E COMPLETED FOR APPLICATION TO BE ACCEPTED Dat' : of (//J Permit Number:SCANNED y - E7 u= B�20610� u RE s`a� ' c+ Y3 Builg�Permit ApplicatioAUG 0 9 Plan'. ing and Development Services 2018 Buil ing and Code Regulation Division t i li g Department 230 iVirginia Avenue, Fort Pierce FL 34982 Pho ' e: (772) 462-1553 Fax: (772) 462-1578 Commercial ie ` rl , FL PER�IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROOOSED IMPROVEMENT LOCATION: Address: \OFSS\ QC_1t� Qc' Se,c�S� FL 3yg j l Legal Dlescription: \J%r.N M•�\ U\\A�ty.+� �ek1 �l o Up 1 ��.'� 3� -k- Q''— k ' Prope I,y Tax ID #: �-\Tjt\-%\0- f-_'30 -Oyy -b Lot No. 8 � Site Plan Name: �� r`e� er , �,� �[ \� A q � Block No. Projects ame: Setbac s Front_ Back: Right Side: �_ Left Side: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: A ddition, wor to e e orme un er t is permit - c ec a app y: Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors _ EI "ctric 9'Plumbing Sprinklers Generator R Roof Roof pitch Total Sq. I t of Construction: \1 oiQ S . Ft. of First Floor: i Cost of C nstruction: $ gzck Utilities Sewer ElSeptic Building Height: i OWNS VLESSEE: CONTRACTOR: Name e—S Name: Address: i % S �C' 3Z Company: City: 791GJzSe_cti Q>e3i� StateS'L. Address: vip03 Zip Code:' 3 "� Fax: City: ��e�cc..•� State: F Phone No Zip Code:!3y%o %k\. Fax: � E-Mail:rwner Phone No.'Z`�,�-01013 )\ Fill in fetle Holder on next page (if different E-Mail. Lye.Sw�%a��w�9 CQfrom thted above) State or County License: If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION': DE IGNERANGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Na e: Name: Ad., ress: Address: Cit : State: %ELL, City: State: l� Zip �by6fAS hone %-a% Ii Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Nar e: Name: ress: Ad c Address: cit City: Phone: Zip: Phone: Zip. OW ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I cert! that no work or installation has commenced prior to the issuance of a permit. St. Lu le Is County makes no representation that is granting a permit will authorize the permit holder to build the subject structure Home Owners Association bylaws covenants that may restrict or such which struct "re. in conflict with any applicable rules, or and prohibit Please consult with your Home Owners Association and review your deed for any restrictions which may apply. I In con ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in acc rdance with the approved plans, the Florida Building -Codes and St. Lucie County Amendments. The foII owing building permit applications are exempt from undergoing a full concurrency review: room additions, accessli ry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use WAR ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for impr'vements to your property. A Notice of Commencement must be recorded and posted on the jobsite befogsthe first inspection. If you intend to obtain financing, consult with lender or an attorney before com encing work or recording your Notice of Commencement. " ' ��ure 4- A49/ .1. Sign of Owner/ Lessee/ContrKtor as Agent for Owner Signature of Contractor/License. Holder TA E OF FLORIDA S A STATE OF FLORIDA Co 7TY OF "afk COUNTY OF S� \,_s.� The f rgoing instrument was acknowledged before me The f " ' �qmenx w Qrgoing inst t as acknowledgopefore me this day of Q0 v- 20 Vrby thi;@ a -day of 20\--% by TAI LN.5\ I Name of person makingAatement Name of person making statement Pers ally Known k-----0R Produced identification Personally Known %_-O"OR Produced Identification Type f Identification Type of Identification Prod ced Produced (Sign ture of Notary Public- State of Florida (Signature of Notary Public- State of Florida Corn Fission No. (Seal) Commission No. STELLA M. HUNTER H U NTER G" OTC. I ...... Notary Public - State of t e of Florida REV � I EWS F Notar Public 4101% iuls S ;,C I. PLANS I � 0,•* VEGETAATTI 0 F F% commission T xpli 180 # FF 180552 a A V � t4tRo eMANGROV co? �RW&Wm Ex Tres REVIEW REVIE ough N; tion EWn. ti EW DATE ..... onded through 13flonal Notary Assn. RECEI,ED I D�TEJCOM LETED Rev. 8/ 17