HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETEL) FOR APPLICATION TO BE ACCEPTED
Date: 112l - F3 Permit Number:
RECEIVED
Ir l r
• � �„ Building Permit Application NOV 2 7 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: K
Address:
Legal Description:
Property Tax ID#: »3� -�OS'O�\s{�Ot6-
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:_
Left Side:
SCANNED
Lot No.
Block No.
amonal worK TO De perTOrmea unaer inls perms—cneCK an indl apply:,, . -
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 14800' OD
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Address: _ If1Cl `TfOP'IG f&A
City: 'Fi Q 1 ua- State: PL-
ZipCode: 34RUV Fax:
PhoneNoA-1ZZ) 51q U313
E-Mail: a 2cfSG,PYli2Cr fnYyi0x1 • CnM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name
Company:
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail
Stgte 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
Name:
Name:
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 apermit 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: roomadditions,
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 toqbfain financing, consult with lender or an attorney before
commencing r recordiW your NOWof Commencement.
e of Owf ssee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOtIIDA
STATE OF FLORIDA
COUNTY OF Oe %%
COUNTYOF
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
this� day of tJaJ zo_a by
this _ day of 20_ by
t
-4 tot. IS 0d '? C % — I-) %-I1 � 1% �5
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced V 1LI t--
Produced
(Signature of Notary P ic- l4d of Flo 9$@NN��� 0GG 022023
`;
Si nature of Notar Public -State of Florida
( g y )
••'t}�'•' MYC0 I$S*N
�lDedembar 18, 2020
Commission No. __' �MoayNbiicUndonudUs
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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