HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLET -_ -:OR APPLICATION TO BE ACCEPTED
Date: I ),/C) 3 /1 �
Permit Number: 13dIa
RECEIVED
Building Permit Applicatian DEC 0 3 2018
Planning and Development Services ST. L
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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REV@9B ffiuff�'� MOON
1Ii 11,ia — 011111121ITI
Legal Description:
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side: 1Z
—Mechanical — Gas Tank — Gas Piping — Shutters
Windows/Doors
311
— Electric — Plumbing Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: D,5-0 S" Sq. Ft. of First Floor: : -1 ; r."
Cost t of Construction: $ � 2vo 0 Utilities: — Sewer _ Septic Building Height:
OWNER/LESSEE: ���tC-ONiTiRA(CC-i7TirtO,.
Name Ale /V
Nam-e.:-
Address: 100 Sumad—
Company:r,,
City: r-onwt 12w1c4ne State: �
Zip Code: -914 q Fax:
Phone No.(7ig)-) W6- 7366
Address:-_,
City: State:_
Zip Code: Fax:
Phone No
E-mail: -,),q A gMa:1, col,17
Fill in fee simple Title Holder on next page ( if different
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.
NFO
SUPPLEMENTALCQNlitST ION LIEN LAW Ill
MATIO
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:
r
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:,A'pplication,is•hereby [Wade fo.obitain a pefmifto�'Ao 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;foll concurrehcy review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory use's 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
commencine work or recordine vour Notice of Commencement.
of Owner/ Lessee/Contractor as
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sit . L oc�Q COUNTY OF
The forgoing instrument was acknowledged before me
this 3 day of U R-4c 20AT by
In' cVA% 1 ")e %N 1
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced L L_
(Signature of Notary P b
t} .%` MMARIEGNENS
Commission No. �TCiO42
D
'p „MDtSSIONtlGG 02Y023
?' ecember 020
16, 2
zZ,7q- '. aoroedTluu Notary PubricundanMters
REVIEWS FRONT ZONING
COUNTER REVIEW
RECEIVED
DATE
COMPLETED
The forgoing instrument was acknowledged before me
this _ day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Public- State of
Commission No.
(Seal)
SUPERVISEGETATIEATURTANGRO
REVIEWOR REV EW I PNSVREVIEWON I S EV EWLE I MREV EWVE