HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP ICABL INFO MUST CONIiI_11ED FOR APPLICATION TO BE ACCEPTED
/ Permit Numb
Date:
SEP 1.8 2018.
_ _ Building Permit Applii O; tting Department
II
Plannl g and Development Services St. Lucie County, FL
euildi g and Code Regulation Division -
2300 irginia Avenue, Fort Pierce FL 34982
Phon : (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER l IT APPLICATION FOR:
7
PROO� E 1N ' R01/E ENT L{+7CA IiJN, "
_
Addre
is: �e �%- �� ��� C _ ...
SCANNED
description: Ay
Legal
St Ucle Cc)un
Propel) y Tax ID #: 1 v / 0 0 00 Lot No.
Site PI n Name: 13hcd Block No.
Proje Name:
Right Side: Left Side:
Setb
I ks Front Back:
QETA1 ED DE�CRdPTION OE W�R�
` eer h(-J /k) I I I' Q.e& In., OluInz
rU rn .
izi
Ct?
S R�l1CT1'0 1�NE4R�MAT1 `,
i
Ional work to be pertormed under t is permit- checK all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total
q. Ft of Construction:: C21 �Sq. Ft. of First Floor:
Cost
f Construction: $ �-1 �g�n Utilities: —Sewer _ Septic Building Height.
l
�W
U IRRLN- f E:
CC NTRACT OR
Name:
Na
a cn7IL
ress: 0 Avc, T
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Ad
Company:
State• _
Cit
Address:
Zi
Code: 4q Fax:
City: State:
Ph
ne N 6. 2 c>v�.'L` r(�p2ln
Zip Code: Fax:
E- I
ail ► i_ LLQ=(J
Phone No
fee simple Title Holder on next page ( i . erent
E-Mail
Fill lin
fro
n the Owner listed above) Y eorxt
State or County License
If va
a of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGN, E
ENGINEER: Not Applicable
_�
MORTGAGE COMPANY: _ Not Applicable
Name:
0170f
Name:
Adds
Address:
City:
s Qr State:
City: State:
Zip:n
2 .i„ Phone 11 •� �'�1� Ie
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 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before , I
commencing work or recording our Notice of Commencement.
turf.fOw ear Lessee/Contractor as Agent f
Signature of Contractor/License Holder.
,nc
STATE OF FLORIDA
m�
STATE OF FLORIDA
COUNTY OF �-
a �� all
COUNTY OF
a�
The for oing instrum nt was. acknowledged before
00
The forgoing instrument was acknowledged before me
this J day of 201 by
a
this day of 20_ by
C 0
Name of person making statement.
'V
Name of person making statement.
Personally own OR Produced Identification
Personally Known OR Produced Identification
Type of Identi a ion
Type of Identification
Produced
Produced
(Signature of N ary Public- State of Flo�'ida U
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
g )
COMPLETED
Rev. 8/2/ 17