HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE�`t64011 APPLICATION TO BE ACCEPTED
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Date: ' 1 Permit. Number:
_ Cq
�- - RECEIVFn
Building Permit Applica ionAUG 2 8 2018
Planning and Development Services ST. Lucie Count ►�c�rrnitkin .
Building! and Code Regulation Division Y` �- ;
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
[VERIVI��IT APPLICATION FOR: Sb J \��. �eha— G aae, Caste
A1�dd o1000 L 1I�, P +"Fer- '544�1 c�C)
Legal Desl rip ion:
PropljTax ID #: �` Lot No.q�
erty
Site Plan'NI ame:� Block No..
Project Name:
i I' �CN6 CPS
Setback Front Back: Right Side: Left Side:
,I
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ice ®'NSTRUCI'ION I INFORMA 11's
n, wor to a pe orme un er this permit — Check a that apply:
—McGhanical — Gas Tank —Gas Piping — Shutters _ Windows/Doors
— Electric — Plumbing _ Sprinklers _ Generator V 'Roof Pitch
�— I �' L "I S Ft. of First Floor:
Total Sq. Ft of Construction: l q.
! Y
Cost of Construction.$ o a6D Utilities: Sewer Septic Building Height:
Name
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City: -pl�
Zip Cod�l
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Phone N1o.
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iE�Mail:
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from the
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r State: L
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Name: Ohl, C 1
Company:. �—`
Address: of Q0 3 RV'44:� Q
City: f�i�r(� State: L
Zip Code: 3 y �1 5i7 Fax:
Phone No � oZ 3 _(Q 8la'7r�
hI simple Title Holder on next page ( if different
Owner listed above)
E-Mail
State or County License
If value of 6onstruction is 2500 or more, a RECORDED Notice of Commencement is required.
S �PPL ]IUI���N AL C � NRS
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DESIGNER/ENGINEER:
Name:
Address:
—Not Applicable
,A.
r''n
fi
MORTGAGE COMPANY: _ Not Applicable
Namt-
Address`'
City:
Zip: Phone
State:
City: _ State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made. to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject strpcture
which is in conflict with any applicable Home'Owners Association rules; bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners.Association and review your deed for any restrictions which may apply.
In consideration of the granting df this requested. permit, 1. do -hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt -from undergoing,a full concurrency review: room additiogs,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before;the,first inspection. If you intend to obtain financing, consult with lender.or an attorney before
commencing work or recording your Notice of Commencement.
�'�nature of ne / Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sk. O I
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this°. day of f 20_" by
this day of 20_ by
S b
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Pub - State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L L
Produced
DEMNAMAit ;PIVENS
Commission No. .Y J %,v I j oG02201
Commission No. (Seal)
EXPIRES: Dece t 16,,2,0�0'
N. o+ 'ThIP publicUndew)(itary
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REVIEWS
F ONT
ZONING
SUPERVISOR r
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
"REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I j�
DATE
COMPLETED
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