HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPUE i ui FOR APPLICATION TO BE ACCEPTED
Date: J I . Qy —y Permit Number: 1-ij) - d S 3
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
RECEIVED
NOV 2 S 2018
Building Permit Applical ion
5T. Lucie Count • Permlttln
Commercial Residential
PERMIT APPLICATION FOR:DQCA uJd�
Address:
SCANNED
Legal Description:tj 5946 L I��(6 L+ Ar k1:]6 ' dfZ S '�4S F1-11-r U % /Z2 6-F
l= //r-n mot-" G'l . \ I I LL mot- Alu l I//i / it -7 Ge,-i
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
ditional work to be pertormed under this permit — check all that apply: " .. ; •i e
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
. QO
Cost of Construction: $ S(Dc::)
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:_
OWNER/LESSEE:
CONTRACTOR:
Name �G j r z k) e 1 l
Name
_ 1
/f� �7,C0
Address: of�S lS;z t 2S2 (y
Company:'.'.
City: yfi State: _
Zip rode: �J���>< Fax:
Phone No. 5L 01 1 aaL5
Address:'
City: State:_
Zip Code: Fax:
Phone No
E-Mail: Zc)2 I r 19 PnnaQi(
b)V9Y'`;
Fill in fee simple Title Holder on next page ( dtf ifferent
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENT 11AGONST 'U TION IM EN LAW INFORMATION:
DESIGNER/ENGINEER:' _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
i
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made-tioobtaih`a perin'it 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
cornmencing work or recording our Notice of Commencement.
Signatu a of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFF. LO c.\-fQ-,
COUNTY OF
The forgoing instrument was acknowledge before me
0 )�
The forgoing instrument was acknowledged before me
this i day of 6) 20 by
this _ day of 20_ by
Name of person making statement.
Name of person making statement. i
Personally Known OR Produced Identification
Personally Known . OR Produced Identification
Type of Identification
Type of Identification
Produced A-_
Produced
(Signature of Notary Pu lic- State o
(Signature of Notary Public- State of Florida )
GFANNAMARIE GIVERS;
,,.
Commission No.Cw(Y NNGGa22023
d 3MYCG78 202U
Commission No. (Seal)
.a oEXPIMES: Deco undanvdtars
BondcdThN NotuY�
REVIEWS
FRO T
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.