HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '� 30 Permit Number: 066
4
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CIO
2
RECEIVED
_ Building Permit Application
OCT3 0 20 18
Planning and Development Services T.Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: � � 5
Address: o�43-0 V'% lane " e r l(e Or, S � L 3 Hy
BY
Legal Description: '
ale County
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2
PropertyTai ID#: 7g15-Z ~,,,�003 —%S-D
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks
Front Back: Right Side: Left Side:
'I�dw",1 Al 'i✓D�iP 1Yi 54� wr
v io9i pf ` JtJ6 ,
Additional WorKtO be performed under tnis permit— cnecK an tnat appry:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters >4- Windows/Doors
V Elect is Plumbing _ Sprinklers _ Generator' kRoof Pitch
Total Sq. Ft of Construction: ,365-5- 54 %f4 Sq. Ft. of First Floor:
Cost of Construction: $ PS7Ja Utilities: —Sower —Septic Building Height:
Name wYYbc✓ `N'ame:
Coriipany , Y'*
Address: ViC��� o� ( �C.cc�•e ��
City: P9r�= el. IJAC-('e State: f'L
Address:
Zip Code: 3 7 / 5� Fax:
City: State:
Phone. No.l 772 - L01 r % 13
Zip Code: Fax:
Phone No
E-Mail: {Awrt�WPS
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
I
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: Not Applicable
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
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.
Inconsideration 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 Iobsite
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.
Signa of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA,� `
STATE OF FLORIDA
COUNTY OF ^I S j(o,(� .
COUNTY OF
C
The f�rpoing instr ent 'as acknowledge before me
The forgoing in was acknowledged before me
this � day of 20 by
this day of 20_ by
(Name of perso ac no ledging
(Name of person acknowledging )
Alf
(Sign ture of Notary ublic- State of Florida)
(Signature of Notary Public- State of Florida )
/
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Iden ' ' do
pe of Identification
Produced ������� KAREN S. NIELSEN
oduced
0 = State of Florida -Notary Publ
c
C ssion # GG 20748
Commission No. =" ,P ag
'.,� Commission Expires
mmission No. (Seal)
',iii��"' June 12, 2022
PLANS
VEGETATION.
SEATURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR.
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
DATE
COMPLETED
ev. 112014
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