HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED D ��
Datl : 1 11-2,0 AG Permit Number:
RECEIVED
Building Permit Application NOV 21 2018
Planning and Development Services
Building and Code Regulation Division
2306 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie County, Perr
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �0
PRO.POSED.IMPROV_EM ENT LOCATION.:
Arirlra« %� J72 I �r',i� �Air�2 )A�l2 �� 1eYC2 L y�q�1
Property Tax ID #: �3�� �� 02 1 ^ OdQ " Lot No._2027M
Site Plan Name: SCANE03lock No.
Project Name: BY
Setbacks Front Back: Right Side: Left Side: County
D'ETAI'LED DESCRIPTION' OF WORK.a
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g ; bQw ee n Dofs 2-7 d-a (ac, je, be�weeraie+ CaraU
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CONSTRUCTION INFORMATION.
Additional work to e e orme under this permit — check a apply: '^� N
11HVAC 13 Gas Tank ❑Gas Piping _ Shutters ❑ Windows Doors
11 Electric 0 Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch
Total,Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ it ��% Otilities:n Sewer []Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name \ qA
Name: Eoci" ,r\m w✓`
Address: Glrt�
City: L State: -
Zip Code: Fax:
Phonie No. (�
Company:
Address " 7
City: I r�State:
Zip Code: g VI,,A1q 1 1 Fax:
_
E-Mail:
Fill in fee simple Title Holder on ext page ( if different
Phone No. x�"1
E-Mail:
State or County License:
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from'the Owner listed above) �rl � o ,j �
If value of construction is $2500 or more, a%RECORDED Notice of Commencement is requirea.
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SUPPLEMENTAL CONSTRUCTION LIEN`LAW 'INFORMATION =.
DESIGNER/ENGINEER: �C, Not Applicable
MORTGAGE COMPANY: Not Applicable
Name.
Name:
Address:
Address:
City',: State:
City: State:
Zip: Phone
Zip: Phone:
FEES 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
whichiis 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 conisideratipn 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 ob ing, consult with lender or an attorney before
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gnat.ure w er Les ee/Contrac or as Agent for
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Signature of Contractor/License Holder
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STATE OF FLORID
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STATE OF FLORIDA
COUNTY OF 1tiC�t�i
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¢ "x a
COUNTY OF
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The forgoing instrument was acknowledged efore
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The forgoing instrument was acknowledged before me
this L day of QQ OV 20J_1
=a'"K.
this _ day of 20_ by
Name of person making statement
J
Name of person making statement
Pers'onally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica ' n
Type of Identification
Produced
Produced
i
a4_
(Signature of Nota ublic- State of Florida)
V
(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
1,,I —
RECEIVED
I I
DATE
COMPLETED
Rev. 8%2/17