HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL
Date
LE INFO MUST BE'W.' IPLETED FOR APPLICATION TO BE ACCE� �;cD _ O
lg Permit Number:
RECEIVED
-- Building Permit Application NOV 19 2018
Planning and Development Services ST. 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT- LO:CATIO,N
Addresls:-�—� �+����,�_� �� St Lucie Count
Legal Description: Tl Cli��„Z.t,. "rd.r�„�S
Properi yTax ID #- �- ®Z.�' (p Elk — OO�j� �— �'���— TL Lot No._
Site Plan Name: Block No.
Prniart Nama•
Setbacks Front Back: Right Side: Left Side:
y s��
lectric 0 Plumbing Sprinklers
i. Ft of Construction: 1
Construction: $ 7--'-7 C> ' Ut
"Shutters
Generator
Ft. of First Floor: _
Sewer O Septic
Building Height:
K'OYN(ER%LESSEECONTRACTOR.
Name I hG�
Name:
Address: 429n_Tlicz) ��
City:,State: _
Zip Code__; � Fax:
Phone No. "—I-
Compan SRI
Address.
City: 4 Stater'
Zip Code:zi'dG��p Fax:
Phone No.277 7--
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:(a���
If value, of construction is $2500 or more, a RECORDED Notice of Commencement is reguirea.
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
— Not'Applicable
Name:
Address:
City:
State:
Zip: Phone:
BONDING COMPANY:
Not Applicable
Name:
Address:
City:
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 forl'
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsit'e
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
AAA_�A=� -
Signature of Owner/ Lessee/Contractor A
Agent for Owner
STATE OF FLORIDA
COUNTY OF ', .
The for oing instrum nt was acknowledge before me
this day of 20 by
Name bf person makinj statement
Personally Known OR Produced Identification
Type of Identification
Produced
Signature of Contractor/License Hold r
STATE OF FLORIDA
COUNTY OF 4
The for ing instruln4nt was acknowledgTdpefore me
this I day of �J . 20by
Name of'pers fi-making statement
Personally Known OR Produced Identification
Type of Identification
Produced t
(Signature of N ic- S'@.q grl LSEN (Signature of Notary Public- State of Florida )
:State of Florida -Notary Public
=' - commission
Commission No :� 9SW107484 Commission No. (Seal)
�i,,o11 "`��` 07711711SS ion Expires
Jule 12, 2022 auu
KAREN S. NIELS
n� sta
s3 d; Commission # G ary
1 OP!�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGE . l' S�Q(4 P R, If C f
COUNTER REVIEW REVIEW REVIEW REV �[ 72, 2 22 R
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17