HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE
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PLETED FOR APPLICATION TO BE ACCEPT6u-
r `ec - <�v Q Permit Number:
�-- NOC. RECEIVED
Building Permit Application NOV 0 s i018
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: 1(772) 462-1553 Fax: (772) 462-1578 Commercial
ST, Lucie county, Permitting
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
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Address:! 113 Q�ec,,A Wsc- CA% i N. H,"ir set IsLA . T1 345 `'I 11
Legal Description: SCA
PropertyTax ID #: I l
Site PlanIName:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK:
V4. �o� �,atsv Ow L . 15,641 $w-Vl it ewc. _
CONSTRUCTION INFORMATION:
Additional work to b e ertormed under this permit -check all t= apply:
11HVA1 C Gas Tank []Gas Piping Li _ Shutters a Windows/Doors
Elel tric 0 Plumbing OSprinklers E Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ d � � Utilities:Sewer Septic Building Height:
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OWNER/LESSEE:' , .:,
CONTRACTOR:
Name G ,—I_ A, s Eliza A N u"o
Name:
u✓�
Address: 1113 Qt , l�sr
Company:
AL
City: ki,1ec IsPJ State: EL
Address:
Zip Code: 3 4 9 4 � Fax:
City:
State:
Phone No;. -�S7 -i&y-! �`� `�
Zip Code:
Fax: - YTY
E-Mail: Nv\j
Phone No.
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Fill in fee simple Title Holder on next page ( if different
E-Mail: el
OE-w C
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Addrelss:
Address:
City: I
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
commencinE work or recordine vour Notice of Commencement. .0.
I
e of wner/ Lessee/Con rac or as Agent for Owner
Signature of Co ractor/L' older
STATEIOF FLORIDA
STATE OF FLORIDA —
COUNTY OF O
COUNTY OF
The for' oing instru_Enent was acknowledged before me
The rgoin Y nstru ent was acknowledgetbefore me
this/ day of 20 by
this da of , 20 b
Name of person malcing statement ✓
Name of person making statement
✓
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type ofldentiflc tin ����1111tIN1111
Produced
/�Ype of Identifl ' n
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A AA �i
ign t i re of Notary Public- State of Florida )s z .f 91998E
(Signature of Nry P otaublic- tate of Florida)
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGE
TLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17