HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1� ,
All APPLICABLE INFO MUST BE 0 ED FOR APPLICATION TO BE ACCEPTEW
Date: Permit Number:
iacey,<P_ RECEIVED
BUilding Permit. Application bEC 10 2018
Planning and Development 5eivices ST. Lucie County, Permitting
Building -and Code Regulation Division -
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 46i-1578 Commercial Residefitial
PERMIT APPLICATION FOR:
Address: 1,8cf 0
Legal Description:
-noz/" - 600
PropertyTax ID #: I'Z 1(52 !71 tv"z'ln' 1 0'0'SX�7- Lot No-
SitePlanName: 1-aC- Block No.
Project Name: 1_47C J,�>C7 1:7 rl
Setbacks FrontL_ Back: _ Right Side: Left Side: — *
Mechanical Gas Tank —Gas Piping
�' Electric v"'Olumbing Sprinklers
Total Sq. Ft of Construction: 1"4 V�o
Cost of Construction: Slmm?�� .1itiW4
Name L de. noar?
Address: ie-14� Aleppader Adf Dir
city: (", �4 r,ig-446, W& 18177 State: �z
ZipCode: a82:Z_J Fax -
Phone No. �60 - 4AR
E-Mail:
Fill in fee simple Title Holder onnext pagellf 'different
from the Owner listed above)
Shutters — Windows/Do.ors
Generator _��Roof �� Pitch
Sq. Ft. of Fir Floor: ltvo _- I
5;, _ �ewer jt'�Septic Building Height:
Z,�J
LL
City:
State: -EL
Zip Code: 3q 4IA51 Fax: -
E-Mail d6's . d )Lq 161 arna I I , 4�'eo rr.
State or County License 464,007?16
Ffvalue of construction Is 2500 or more, a RECORDED Notice of Commencement Is required.
.:N�
DESIGNER/ENGINEERP Not Applicable MORTGAGE COMPANY: Not Applicable
Name: M92V Name:
Address: 18 -35 �Zo"" Address: State:
City: V&(*o 13e_p4irlb state: city:
Zip: �.Z q 0 Phone,7 -7 7- - nn"E" 512, Zip: Phone:
-FEE SIMPLE TITLE HOLDER: NotApplicable
BONDING COMPANY: __Not Applicable
Name:
Name:
Address:
Address:
city:
Zip: Phone:
city: Phone:
rip:
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 permt.
ture
St. Lude Coun ' makes no representation that is granting a permit will authorize the permit holder to build the subject struL
which is In cc ilict 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 re ' strictions which may appli.
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 concurrencir review: room additions,
accessory structures, swimming.pools, fences, walls, signs, screen rooms and accessory. uses to another non-residential use
WARNING TO OWNER: Your fallureto Record a Notice of Commencement may result in your paying twice for
improvements your property. A Notice of Commencement must be recorded and posted on the jobsite
before the firMionspection. If ou intend to obtain finan ing; consult m(fth lender or an attorney before
itn -ice oofLi !4n
commencing work or recordin our Notice of Comme cemen .
Ur Imo
or OrC OLT
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Zncinwor,k
rw rtr as Agel
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Signa Ure,6towfigr/ Lessee/Contractor as Agent fo owner
STATE 01: FLORIDA 41. 1;
COUNTYCIF
Can ctor/Ucense Holder
�J_gnt��o Ccihti�actor/ucense Holder
tu 0
rc r1c ce fIllina
STATE OF FLORIDA
COUNTY OF�
The Ing instLiumerit was acknowledg d before me
thislo2clav fs-teo by
The forgoing instrument was acknowledged before me
this _ day of 20L_ by
(Name of person acknowledging).
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State bf Florida
Personally Known _ OR Produced Identification
.Type of Identifi tion __7
Produced
Personally Known OR Produced Identification
Type of identification
Produced
Commissio N KARE LSEN
9;9),blic
COMM! sio G 207484
C ission Expires
MOO J no 17, 4—
REVIEWS G SUPERVISOR
COUNTER REVIEW REVI
Commission No. (Seal)
PLANS
REVIEW
VEGETATION
RWIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
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