HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONX.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
O Permit Num
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Building Permit kipplicatioll
Planing and Development Services
Bull and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Pholi e: (772) 462-1553 Fax: (772) 462-1578 Commercial
AUG 2 3 2o18
Permitting Department
St. Lucie L
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PER�11T
APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:
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Prop rtyTaxID#: j'3Ci1 —(905-00V.3rpO0-3 Lot No.
Site Plllan Name: Block No.
Project Name: � D�.
Setbalcks Front Back: Right Side: Left Side:
Aaaitionai worK to oe errormea unaer finis permit— cnecK an apply:
HVAC+ _ Gas Tank Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers I—J Generator _ Roof % Roof pitch
Total Sq. Ft of Construction: `ZOO S of First Floor:
IIIIQ�
Cost dlf Construction: $ O _ Utilities. -In Sewer 0 Septic Building Height: I CR
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NamejC_'(V�s
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Name: Y O C Q) io
Addr
Company: l Le
ass: 30 SCA-) LCLkk V(L
City:
Address: ( SC� AJGCaC( (S__(.-►_)
State: Q'C—
Zip Cir
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City: �G\'X �" State:
Phone
No. —7V- (Q 30 OS-1 S
Zip Code: 134ctl)7 Fax:
E-Maljl:
Fill in
Phone No / C
E-Mail:
simple Title Holder on next page (if different
from
fee
lihe Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. pC W O "/ Z�'.
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GNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
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Name: '
ess:
Ad
Citv',
Address:
City: State:
State:
Zipl
Phone
Zip: Phone:
FEE
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SIMPLE TITLE HOLDER; Not Applicable
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BONDING COMPANY:. ... _Not Applicable
Name•.
ess: :, :::, :.:
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Address: .
City:
Phone:
Zip: Phone:
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OW ER/ CONTRACTOR AFFIDVIT: Application is hereby'made to obtain a permit to do the work and installation as indicated. .
cert that no work or installation has commenced prior to the issuance of a permit
St, Lul le Countyconflict makes no representation that is granting a permit will authowhicrise the permit holder to build the subject structure
h s in with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
struct re. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In cons' deration of the granting of this requested permit, l do hereby"agree that I will, in'all respects, per
the work
in a -cc irdance 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 concur"rency review: room additions,
acces� ry structures, swimming pools, fences, walls, signs,.'screen rooms and accessory uses to another non-residential use'
WAF I JING 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
befo a the first inspection. If you intend to obtain financing, cons It with lender or an attorney before
cbM encinR work or recording our Notice of Commencement.
_-
ign ture of 0 ner/ essee/ ntractor as Agent for Owner ignature Contr or/LI ense Holder,
CO�E OF FLORIDA ' STATE OF FLORID _ o
NTY OF - C COUNTY OF m{ n
s :WCW
The Ing instru nt was a knowI dgty efore me The forgoing instru nt was acknowledged befo � �—,
Q0// m this'' ` ay of 1/ 2 by this day of 20ty z w o =
o zc
Na'ma ofp�erson maki statement Name of person making statement ` a�
PeTs n f K� _ OR Produced Identification Personally Kn w OR Produced Identifica `V
yp of Identification Type of Identificati
Pro' ced Produced
Si
(Sig atur of Notar ublic_- State of Florida) � (Signature of Not Public- State of Florida )
Comlission No.16?17,`, J. (Seal) ' .' Commission No. (Seal)
�
RE IEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED• .. ,
COMPLETED
DAT
Rev. 02/17
Notary Public State of Florida
Harold Otto .
My commission GG 217553 -