HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST 5B7E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 % , � - ) U - Permit N4
Building Permit Ap
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
.03
DEC 17 2018
Permitting Department
St. Lucie County, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I "Vfi III
Address: _I J li r7L r-) S t Y7 Cl ( Cn n Cl--j V`c-r fe-n V e- _ 4e- n ben r� rat r� �
Legal Description: t .Gf 4c r n Cl n Dt" ri�� rx_� ( D o.3t r -h IBC
(/9i2 Z-?0b— 127,Q
PropertyTaxlD#: U S-Pq `Q Ltd- Q05U-000— 2 SCANNED Lot No.
Site Plan Name: BY Block No.
Project Name:
Setbacks Front Back:
40 wwl� dam- • a
FArwnrc- h&'&-
S
Right Side: Left Side:
z>u.1< v-�amQ cPa`.�ii-• � I-S'f�� Sw R , ht �rtiE'r.r_«�a-a
t••. Quad( a 6 G S- V' - -- c �.1�"�
HVAC L__JGas Tank LfGasPiping
Electric 0 Plumbing []Sprinklers
Total Sq. Ft of Construction: ).3 CI a
Cost of Construction: $ ifl0 RV• DV
Shutters Windows/Doors
Generator Roof Roof pitch
S . Ft. of First Floor: _
Utilities:Sewer Septic
i
Building Height: /8
Name t 1
Name: d sC_4f oklin
Address: �2 rl S (r)d-ion 2i V
ompany: Co! rl r
i?Q0
City: 140 ,- n %/GI (li- State: �
Zip Code: 3UCGS8 Fax:
Phone No. -?l ) 2 33 - 03e7 (o
Address: I S S•
City: I S te)�::L
Zip Code:
Phone No.(77i)
E-mail: &4(1 b(a")P_ a nr)(.�,TSr(-n 'Q)(;4
Fill in fee simple Title Holder on next page (if di rent
from the Owner listed above)
-Mall:
State or County License: CC C Q?> as72
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEIVIENT�ACCONSTRUCTION<CIEN LA1NtINF®RMATION�
�� st,��« �.�`, ttiy�; �,µE ;� � 4�'' ��,
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State: _
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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,
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
commencing work or recording your Notice of Commencement.
. 2
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor tense Holder
STATE OF FLORID{
STATE OF FLORIDA,,.
COUNTY OF GI P,
COUNTY OF fit 1 Q
The forgoing instrument was acknow edge before me
this i� day of be r n IBC 20I by
The forgoing instrument was acknowledged before me
this J t:i7Hay of ?/ (A m il21� . 20�19 by
Pray PM.4 of OVA
't-30cl s-,44n
Name of person making statement
Name of perso ma statement
V
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced( S9 fat- O/C)Z)— Lll^v- 01) C)
Produced
C-�,kM I II'I/► �) Y�/Yl
(Signature of Notary Public- State of Florida)
(Signature of NotaryPublic- State of Florida )
Commission No. "I (o
mission Nof" 6 i0
je'0+ Notary Public State of Florid
® Jennifer Davis
Notary Public State of F
c o My Commission FF 966029
, Jennifer Davis
or n xpu
s
?orn
xplres02/29/2n20
REVIEWS
FRONT
NS
VEGETATION
SE �
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17