HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE I INFO' MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date U SCANNED Permit Number: °
�.���ol®u��V BY
RECEIVED
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Building Permit Application AIIr 10 2018
Planr ng and DevelopmentServices Permitting Department
St. Lucie County
Build' g and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Pho �e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
11
PER
IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRO
,OSED ;IMPROVEMENT LOCATION
Addr,
Legal
Prope y Tax ID #: Tf A0 -Woo
Site PI n Name: �1 _ 6-
Projec I Name: a V1
Setba , ks Front ^Back: Right Side: Left Side:
DET 'ICED DESCRIPTIQN (7FINORK
Lot No.
Block No.
CON TRUCTION IN.FQRMATION
s=
it bnal work to be nertormed un er t is p mit — c ec a apply:
VAC L_J Gas Tank Gas Piping _ Shutters a Windows/Doors
❑ Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total q Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 'VV Utilities: _Sewer Septic Building Height:
O{W
ER%LESSEE_
Name
Addre
City:
Zip CIA:
Phan
E-Ma
Fill in
NA ae I -
Name:
Company: C1CVCr,
Address: 1, 1 'fu 'T
s: • ` IV%U,
6W State: j
Fax:
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City: 9 State:
Zip Co e: Fax: Z�
Phone No. " (
7
ee situp a Ti a Holder on next page (if different
E-Mail: ( I d4
from
e Owner listed above)
ii
State or Coun y License:
I If valuo of construction is $2500 or more, a RECORDED Notice or Lommencemem: is requires.
5U
pLEMENTAL CONSTRUCTION LIEN LAVA INFORMATION:
DES
Na
Add
City:
Zip:
GNER/ENGINEER: _ Not Applicable
'Ie:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
less:
State:
Phone
I
City: State:
Zip: Phone:
FEE
Na rr
Add
city
Zip:
' IMPLE TITLE HOLDER: _ Not Applicable
i1e:
BONDING COMPANY: Not Applicable
Name:
ess:
Address:
City:
I Phone:
11
Zip: Phone:
OWN�R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi that no work or installation has commenced prior to the issuance of a permit.
St. Luce County 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
struct 1 e. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In con }deration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acc tclance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fo lowing building permit applications are exempt from undergoing a full concurrency review: room additions,
access 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
befor 2 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
..I, — --A;-- — Ain+ire of r nmmcnromont
Alf
Siglure
of Owner/ Lessee/Contractor as Agent for Owner
Sig 're of E'b_nt_r_a_c_Fo—r71Ice—M6 Holder
STATE
OF FLORIDA
NTY OF I IC�JIy' I 1
STATE OF FLORIDA `rl
COUNTY OF
CO
The
orgoing instr ment was acknowledge efore me
The for�ing instrument was acknowledged before me
�— Q by
this
day of 20 by
this day of 20
Name of person making statement /
Name of person making statement
Persi
nally Known OR Produced Identification
Personally Known OR Produced Identification
TypeI
lof Identificatio
ntification
Produced
OESIREEFI,
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No" Pt
1s f Florida
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ature of No ary Public- State o
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:°. Notary Public - Sta of trida
Commission ' '
C m
ission No.
•= ission � FF937jQ78
:N� • ♦ J,` My Comm. Expires Oct 22. 2019
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Banded through'NationaiNotaryAssn. ,
RE
HEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DAT
REC
IVIED
DAT
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�PLETED
Rev. 8/2/17