HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONj All AP ICI �LICABLE INFO MUST BE COMPLh-,-'11'D FOR APPLICAi'IOWTO BE ACCEPTED 1
Date; �. �Y' • �' Permit Number: / ?o %— 0-�i /
- Building Permit App icatiorJEP 2 4 2018.
Plan l'ing and Development Services Pei mittin ®��i«; ti� eilt
Build, g and Code Regulation Division St. Lucie C®LIn
2300IVirginia Avenue, Fort Pierce FL 34982 y FLPho : (772) 462-1553 Fax: (772) 462-1578 Commercial Resi entla
PER "MIT APPLICATION FOR: JIB �
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PRaPC�)SED UNPROMINVI, NT LOCATI®N:
A dr�e b'—AW F— Ae,rl RA. 61 Lucie Co unfv
IILegal Description:
Fro ert : Tax 1 D #: �)^�"o(N U( U.UU U W
Site PI IIn Name:
Proiec , Name:
IISetbjks Front Back: 'Right Side:_ Left.Side: _
Lot No.
Block No.
0 ST ffil N INFORMATLON:
itI!I nal work to be performed under this permit —.check all that apply:
_ echanical Gas Tank —Gas Piping _ Shutters _ Windows/Doors
lectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
i
aL II ��Ft of Gonstr•.uc Ion'- Sq. Ft. of First Floor:
t:o Const�u.cti , ' 'a.$ c)b Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam '
Address:
City:
Zip Oi
Phonil
E-Malj:Y
Fill in!,fee
from
Name:
Company:
I, State-ElAddress:
de: C Fax:
No,33C�219(offb
City: State:
Zip Code: Fax:
Phone No
VrsAAi��1��. <o0-\
simple Title Holder on next page ( if different
the Owner listed above)
E-Mail
State or County License
If valuel,of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S DPP E . EN
CCa? STR+U
TI � N l.�N �� t
fORMA O o_
DESIGN R ENGI
ER: _
of Applicable
MORTGAGE COMPANY: _ Not Applicable
Name•
Name:
Addr ss:
�u
-
Address:
City:
te Sta:
City: State:
Zip:
Phone�u + 5
5, a1�_
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: Not Applicable
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 certifyi that no work or installation has commenced prior to the issuance of a permit.
jIVSt. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which isl in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
ct struure. 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 accorI ance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
I
The follQwing 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
befo'r6 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commebcinl? work or recordinl? vour Notice of Commencement.
AI
Sign , e bf _
r/ Lessee/Contractor as Agent
r '� yy' r
Signature of Contractor/License Holder
�
STATE/OF FLO
o
STATE OF FLORIDA
X�a
C 0 L I TY OF
= �
COUNTY OF
mCD
The forgoing instr ent was acknowledged�efor
r Z
The forgoing instrument was acknowledged before me
thi ay of
20 by
c _
this day of 20_ by
`ryA`
A
Name of person making statement.
a
Name of person making statement.
Personally Kno
OR Produced Identification
Personally Known OR Produced Identification
Type of Iden ificati
Type of Identification
Produced
' • C .
Produced
d
A
(Sign ture of Not Public- State of Florida. '
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
(f7
DATE
COMPLETED
ev.