HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll Aqq PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dllte: Z� 2 Permit Number: N09 0 0 W
SCANNED
BY
St Luc!, CEO, LRECEIVED
1i1 Building Permit Applica ion SEP 0 4 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Pvrmiti ing
23p0 Virginia Avenue, Fort Pierce FL 34982
P lone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
P 'IRMIT APPLICATION FOR:U�CMt
PROPOSED 1!N'PR01lEM�iUT Lt?C 1'I�N:
Add Cess: iqOnol
Legz I Description:"/3 35 3 ci m Al LorI iie'r ,, Nw � .�/.L��I .ZJ-3 f ,.1 '7 4w VD C4Tb 26,
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rtyTax ID#:fv" 000—[e Lot No._
Site Ian Name: Block. No.
Proj ct Name:
i
Set lacks Front Back: 3 6) f Right Side: Left Side: S
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Additional work to be performed under this permit— check all that apply:
11IMechanical _ Gas Tank _ Gas Piping —Shutters' _ Windows/Doors
1 Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total ISq. Ft of Construction: f" Sq. Ft. of First Floor:,
Cost l f Construction: $ D �. Utilities: —Sewer _Septic Building Height:
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fee simple Title Hol er on next page ( if different
i the Owner -listed above)
State or County Li c nse
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
StJ � PLE : EN m=
In
DESIGNER/ENGINEER:
Name:
_ Not Applicable , :
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
I I'
Address:
City:
State:
City:
State: II'
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable „
Name:
Name:
Address:
I
Address:
City:
City:
Zip: Phone:
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, structure .
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 of this 'requested permit, I 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 additions,
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 job
site
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine work or recording vour Notice of Commencement.
S' ature of 6wnssee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ��oo
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instr ent was a knowled$ d before me
The forgoing instrument was acknowledged before me
this � day of 2dby
this day of 20_ by
JCc GpekC A Ile 1�
S4.yl f /
(Name of person acknowledging)
(Name of person acknowledging)
'gnature of Not ry Public-Stateof 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 SusanGraceMfler
Produced
NOTY PUBLIC
Commission Nci.iJ �( 9EE OF FLORIDA
i,pm
Commission No. (Seal)
aFF9165W
1010
REVIEWS
FRONT '
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014