HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONDILL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE
gate:— �• ACCEPTED' �'QQ�''
" Permit Nu r:�—
SCANNED
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I!Building Permit Appllcati n AUG
faSt. LU(Ne
Cou
nning and Development Services 7 2018
11Iding and Code Regulation Division Pe rm I ttl fi
00 Virginia Avenue, Fort pierce FL 34382 9 p rt e I� t
lone: (772) 462-1553 Fax: (772) 462-1578 Commercial esi en
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ReSI Yr FL
FPROPOSEOIM
RMRMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I
I
PROVEMENTLOCATION:
Address: �5 ��% n - O(i f' Q- s LW �^
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Legit I Description: 2 -- -F-.Q �eSe �Ve S
I I pV q l ass
Proerty Tax ID #: (OCO - a 3_r� - ry-n—
Site Plan Name: Lot No.
Pr oj ct Name: O-S+t-c CI Block No.
Set)acks Front AJ � 4Back: Right Side: Left Side:
DEAILED DESCRIPTION OF WORK:
3O'
to �� ln"a �� o� ezccs��
CONSTRUCTION INFORMATION:
rt°ona wor to e orme un er t °s permit - c ec a
IHVAC n aPP y_
I Gas Tank ❑Gas Piping Shutters � Windows/Doors
i Electric � plumbing L�JSPrinkiers
D Generator Roof Roof pitch
Total , q. Ft of Construction: _Iqq(�
S Ft. of First Floor:
Cost I� Construction: $ l(V (p C)(D Utilities: Sewer Septic Building eight: H '
i (�
OWNER/LESSEE:
CONTRACTOR:.
Name �( G(I C°
( Name: �
Addre S. Lii')Il0
Company: 1'�,
City: I L W 1A111 i i1um
- State: Z Address: �q
Zip Cc! 'tie: 3 Fax: City: P L
Phone ,�l0. State:
Zip Code:
E-Mai r Fax:�� �= ; 1�-2 -Q!
•- _ ,,,
Phone No. 2 QZ-- lq
Fill in f leIIe simple Title Molder on next page (if different E-Mail:
from the Owner listed above) S I �ufhlrl
State or County License:
If value'f construction is 52500 or more, a RECORDED Notice of Commenceme is regalred.
i
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ns i"ALCC}`IST ��
kU„C"j(�N f�LA1111>*NUi
®ESIGNER/ E .a�s�<
GINE�R: Not Applicable
ame: MORTGAGE COMPANY: _Not Applicable
Iddress: - Name:
ity: Address:
State: City:
Ill ip: 3 Phone Cf _ S State:
ZIP: Phone:
SEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: ame: ____Not Applicable
ddress: Name:
)lty: Address:
11 P: Phone: Z ity:
p: __. Phone:
In
in
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im
be
this
Pe
VER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
Jfy that no work or installation has commenced prior to the issuance of a permit.
cie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
i is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
ure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
isideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
ordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
Ilowing building permit applications are exempt from undergoing a full concurrency review: room additions,
;ory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
KING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
wements to your property. A Notice of Commencement must be recorded and posted on the jobsite
e the first inspection. If you intend to obtain financing, consult with lender or an attorney before
fencing work or recording your Notice of Commencement.
k
of 0 >r�ner/ Lessee/contractor as Agent for
TE OF Ft
9NTY OF
ing instrum%11Wa&acknowledged efore me
day of20jby
Name of person making statement
finally Known I/ OkProduced Identification
of Identification
of Notary Public-
Comrssion
E
Rev. 8/
Liza;• ruunu Jtate t Florida
D Mayfield
i My Commission FF 24 393
OfA47;0"
Signature of Contractor/License Holder
STATE OF FLOR
COUNTY OF , Lt4z_cz
The f r oing instru ent as acknowledged before me
this day of by
Id
Name of person making statement
Personally Known _Jk�,/ OR Produced Identification
Type of Identification
Produced
Aat �OfNotmry Public- S e f Florida )
Commission
�' - LVIVIIVl7 'UFERVISOR
COUNTER RpE�VIEW REVIEW R
rvotary Public State of Florida
Liza D Mayfield
r My Commission FF 2433aa
" "m I 11K ILr - MANGROVE
REVIEW REVIEW REVIEW