HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi•
I APPLICABLEINFOMUST BE COMPLI FOR APPLICATION TO BE ACCEPTED
Date: /v R ' Permit N 42L�.� rRFr,1:1VED
Building Permit Ap IicatiOWC 26 2018
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM TYPE: L�� �C kz, S.
PROPOSED INPROVEMENT LOCATION:
Address:
Property Tax ID #:�
Site Plan Name:
Project Name: p.Q4 o ,\J -
DETAILED DESCRIPTION OF.'WOF
CONSTRUCTIO" WINFORMATION::
5 5c\-0 0() -
4 OA, lk�j
SCANNED
Additional work to be performed �� under this permit- check all that apply:
V.r.rS .
\&Mechanical 3 _ Gas Tank _ Gas Piping _Shutters
_ Electric _ Plumbing _Sprinklers _ Generator
Total Sq. Ft of Construction: do Sq. Ft. of First Floor: _
Cost of Construction: $- Uhl Utilities: _ Sewer _Septic
Lot NoA(0•
Block No.
Windows/Doors
Roof Pitch
Building Height:
.OWNER/LESSEE:
CONTRACTOR:"
Name wrYO•w.
ame:
Address:`N S_,
Company:
�(`
city:\ D. `4@- Q'zzy � State:_
Zip Code:r-'--,)34 60 Fax:
Phone No (O\ (o 7-L 35
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Hold 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 requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
LAw INF0
INEER:
Address:
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:v J9pM as
Address:
Zip•`!34 i6o Phone: S to\ 506 Z a5�
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:_
Zip:
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
I
mprovements 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 our Notice of Commencement.
N
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Signature of Owner/ Lessee/Contractor as Agent
ffq,-,-466
Signature of Contractor/License Holder
STATE OF FLORI
SZp �d
m �g
STATE OF FLORIDA
COUNTY OF
moow
COUNTY OF
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mcw a
The forgoing instrpment was acknowledged bgfor
C '
The forgoing instrument was acknowledged before me
this,day of J 20�1 by
this day of 20_ by
_
Name of person'making statement.
-•a;"""
Name of person making statement.
Personally K own OR Produced Identification
Personally Known OR Produced Identification
Type of Iden ifi tin
Type of Identification
Produced
Produced
(Signature of Notary Pubol State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9/Lb/l.b