HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FORAPPLICATION TO BE ACCEPTED
Date: .UWo,N�.�,h��,aoi O Permit Numbe
KLULIVED
Building Permit Application NOV 2 0'2018
P►an�ingandDevelopmentServices Permitting Department
Building and Code Regulation Division St. Lucie Count FL
County,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 6C.A►NNED
PR®�POSED I�M'PR(�71/EMENT LOCATI®N: �� ' _ �. ,,
Address:
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Legal -Description: --�
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Property Tax ID #: 11_1�t) 4 nCa__f IT)k 5�) -(-)(1 C> - � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D'E1'AIiKD DE=MSCRIPTI®N OO F WORK:
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C®NSJTRHCT ON�0011'RMATION:
itioi a workto jepe orme under this permit -check a apply:
L�HVAC l Gas Tank ❑Gas Piping Shutters Windows/Doors
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Electric ElPlumbing Sprinklers E Generator _ Roof 'Roof pitch
Total Sql Ft ofConstruction: in S . Ft. of First Floor:
Cost of Construction: $ Utilities: 0Sewer ElSeptic Building Height:
01IUNEFR/LES�SE'E:
C®NTRACTOR:
ame:
Company: �C�U4i� _a -
Name E?
Address A q 0
City: _e r-c- State:
Address: q 0 3 �
Zip Code: Fax:
city: Veik7 ppue� State:
Phone No. - 01-
Zip Code:aq Qc� Fax:
E-Mail: I
Phone No.
Fill in feed simple Title Holder on next page ( if different
E-Mail:
from the lOwner listed above)
State or County License: C` C0-50c,091
If value of'construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City;:
State:
City:
State
Zip:l Phone
I
Zip: Phone:
FEE
ISIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Applicable
Name:
_
Name:
yNot
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.
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,
access ry 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
beforee-the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
The
this
of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
OF FLO STATE OF FLO
rY OF - "0 i� COUNTY OF �,
in.strur,nent was acknowledged before me
Of t( 20AR by
Name of personDOng statement
Personally Known OR Produced Identification
Type of Identification
Produced
Jag -
(Signature of Notary Public- State f I
hlic State,of FWiide
Commission No. P Sanderson
My Commission GG 211256
Expires 0412512022
EWS IFRONT
COUNTER
COMPLETED
Rev.8/2/17
The for ng instr ment was acknowledged before me
thig��yofby
(�
Name of perso ing statement
Personally Known OR Produced Identification
Type of Identification
Produced
III - Ail Jt A_J L
re of Notary Public- State of Florida )
No. C� B
ZONING
EGETATI
REVIEW I S REVIEW OR I REVIEW I PLANSVEV EWON
h8@9 Public -State bf 0166d
Amanda P Sanderson -
My Commission GG .21125E
Expires 04/25/2022 .
:A TURTLE MANGROVE
REVIEW REVIEW