HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP CTET� FOR APPLICATION TO BE ACCEPTED
Date gamTRO-9 �Permit Number: —V%�
S
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SCANNED
Building Permit A'�pplicati n sEP 0 5 2018
Planning and Development Services ST. Lucie County, Permitting
euildrI g and Code Regulation Division
2300 (Virginia Avenue, Fort Pierce FL 34982
Pho e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER �11T APPLICATION FOR:
Address
11 s: (l `i (,� a
sal C� r
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3"y7
Legal I
escription:
2--0
Property Tax ID #:
Site PI n Name::
Projec + Name: _
Setba Front
Back: Right Side
Left Side:
V r A..nAA i IMF ,,, /L A _A,L n
Lot No.
Block No.
Haaitipnai worK to oe perrormea unaer tnis permit— cnecK aii tnat appry:
II echanical _ Gas Tank _Gas Piping _Shutters _Windows/Doors
lectric — Plumbing _ Sprinklers . _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:.
Cost o1 Construction: $ b , RAo Utilities: _Sewer _ Septic Building Height:
Nam
Addr
City:
Zip
Phone
E-Mail:
Fill i
from'(
moo.. r
Name:
ass ' � �
Company. . t �(6 r``C.d At 5j'►AAh,1
Stater4
de Fax
No. 7'Llvr 2�.
Address:".'12-Afli('oriU/1►'l�-s
rCity: ''''" State:—RL
Zip Code: �?� 6 6 Fax:
Phone; No
• 4U'l e qo-Q -CdYt
fee simple Title Holder on next page ( if different
he Owner listed above)
E-Mail M(aU C,L, C- WS-►c-�1N+ LIU� ,[ems
State or County License �;G -) 5 f"0
If value of construction is 2500.or more, a RECORDED Notice of Commencement is required.
DESIGNER(ENGINE Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: U01c✓K
Address:
City: State: �
City: State:
Zip: Phone :1 - ,� 9 —e
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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 Associatiomrules, 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. I;
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 jobsite,
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
.Signature of Owner/ L ntractor as Agent for Owner
Signature tractor se Holder
STATE OF FLORIDA
STATE OF FLORIDA-
COUNTY OF �_i)�,( . •
COUNTY OF
The f�oing instru ent w s acknowledged before me
The f oing instr ent wp s acknowledgeVefore me
-
this day of 20 by
this day of 20 by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida j
(Signature of Notary Public- State of Florida )
L-
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identif' on
LD
Type of Identifi on ;I
oduced_(� bL
Produced
,,,• ,, F-,,. ,KAREN S. NIELSEN
;_� st e.�of Florida -Notary Public
Commission No. _. .. C�i)ssion # GG 20748
������ KARE(��I' IELSEN
mmission No. •, .•`�aroJ', '
Notary
11h0F f•��� My,Com.mission Expires
_� . �, tate of F orida
r Public
.. .- Commission # GG 207484
June 12, 2022
+, A`
June 1
; 2022
REV.I.EWS.
FRONT
ZONING .
SUPERVISOR
PLANS
VEGETAT,
COUNTER
REVIEW
REVIEW
REVIEW
REVIEVV_A
REVIEW ' :
REVIEW
DATE
RECEIVED .
DATE
- -
_I_
COMPLETED
Rev. 7/2014