HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONni
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTE-D---
Date: Permit Number: L)
SCANNED
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VED
CEIVE
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EP 18
SEP 0 6 2018
tion
Building Permit Applic ;Ln Co
ST, Lucie County, pal--
Plann'lill L
ng and Development Services Itting
Buildl g and Code Regulation Division
,l
2300 Wrginia Avenue, Fort Pierce FL 34982 -
Phone!: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
, 70 /J, 14
Addres1.: e-L
Legal D.,scription: e�9;6 v
Properly Tax ID #: 03 — 1-3 0— 0
Site Pla 61 Name: yna-) I- L---'
Project'dame:
Setbacks Front Back:
T
DETA6LED If iD "E4.0
— I I f I f., r
Q11lliipos
-7
OW/ - 1201
Lot No._
Block No.
Additi, na workto e performed under this permit 7 check all that apply:
N1 echanical Gas Tank Gas Piping Shutters Windows/Doors'
Electric Plumbing Sprinklers Generator_�Roof Pitch
Total S61. Ft of Construction: Sq. Ft. -of First -Floor:
J/ I
Cost 0I ��Construction: $ 2b &V15 Utilitie' S'ewerBu'ilding Height:
,
Name
Addr
City-
Zip C
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Name: -I-n ree" ev, I /'c
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company: a to (VI filar t,
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Address: /196;� llw"
City: Ve ni bewe 4 State:
Phone
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No. j %3.21
Zip Code: 3LWO Fax:
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Phone No 7 S��j I-/ gg
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simple Title Holder on next page if different
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he Owner lasted above)
State or County License C&C 03 4']Y-91
If valud.l'ib.f construction is 2500 or more, a RECORDED Notice of Commencement is required.
agada M NT 1 C « NST 10410 11 , W INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ of Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
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
is in Home Owners Association bylaws
which conflict with any applicable rules, 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 jobsite
before the first inspection. If you intend to obtain financing, consult with I er or an attorney before
commencing work or recording our Notice of Commencement.
Signatur o Owner Lessee/Contractor as Agent for Owner
tractor/License Holder
Signature oZORIDA
STATE OF-(�,v„�
STATE O
COUNTY OF
COUNTY OF Sir L.cIG:�-c
The forgoing instru ent was acknowledgee before me
The forgoing instrument was acknowledged before me
-this
this day of 20l by
-_ day of 20_ ?by
Name o . erson making statement.
Name of person Raking statement.
Personally Known R Produced Ide i
Personally Known OR Produced Identification
Type of Ident' ' tion \,k"1415013NWIC0
Type of Identification
Produced NotaryPublic- California
Produced
Z Santa Clara County >
Commission p 2237904
Of
My Comm. Expires May 11, 2022
Xof
(Signature of Public- State of Florida)
(Signature Notary Public- State of rida.)
Commissio o. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17