HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED "
Date: • - .,Permit Number: _ IF K l70
V 7g:201MR11
' r
SEP' 201
Building Permif' plication
Planning and Development Services SCANNED Permitting (W qpa ti"hent
Building and Code Regulation Division By
Ito hllCle CoU ty, FL
2300 Virginia Avenue, Fort Pierce FL 34982 Lu�9e County
Phon : (772) 462-1553 Fax: (772)'462-1578 Commercia Residential
��ERMIT APPLICATION FOR:^T����
AddresI 15 � 'l (O �l�%R � � l� . -FT a 1 e et-e
Legal DI scription: 00 t i
Prope
Site PI
Projec
Setba
Total
Cost.
Tax ID # 2 t.� /9 (co77 �3 � O O O'
Name: p
ame:1�
Front Back: Right Side: r Left Side:
Lot No._
Block No:
nal work to be performed under this permit— check_ all that apply:-.
echanical _ Gas Tank _ Gas Piping _ Shutters indows/Doors
e#ric _Plumbing _ S rinklers _Generator ✓oof2 Patch
Ft of Construction: / 6,0 7 Sq. Ft. of First Floor:
' � N
construction: $._ D®Q _ ± Utilities: _Sewer _Septic Building Height: /
'� % A Xi9� -
Name L�Wlt
Address: J� �� �P K)0.\ty�
City:State:ELI
Zip CI de: Fax:
Phone No. 30
E-Ma i I: 'C \ Q r \S -C
Fill in fee simple Title Holder on next` )age ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or.County License
If value of construction is 2500 or more,-4 RECORDED Notice of Commencement is required.
.y
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: /ric.,
Name:
Address: �8 Gd i ��
Address:
City: Stater .,—r,7
City: State:
Zip: - 8 Phone liF77P
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
whiWis 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`i-eview 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 CountyAmendments.
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 accessoryuses 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 Iproperty. 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 o cement.
_ .
"J�gnatur
Owner/ sse or as Agent for
er,
Signature of Contractor/License Holder
STATE OF FLORID
2
STATE OF FLORIDA
COUNTY -OF �J
y
COUNTY OF
=
The forging instru ent was acknowledged before m
;,-n=
The forgoing instrument was ack wled'ged before me
this day of 20LF• by
this day of 20_ by
.ale a a
N
Name of person making statement.
Name of person maki statement.
Personally, known ". OR Produced Identification
Personally Know OR Produced Identification
Type of Identifica i /�,
Type of Identi 'cation
Produced Y' �`
Produced '
4.,.
:-
��
s
(Signature of N ary Public- State of Florida)
9G
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]
�1n
DATE
COMPLETED
Nev. 8/2/17