HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `• Date: I +. D_�`.Jej Permit Number: r2 0Y— L?5c�>S`
bL ANNED
BY
St, Lucie Countv
Building Permit ApplicatioRL"CEWE®
Planning and Development Services
Building and Code Regulation Division APR 2 5 2017
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Re, h rVA>4-i i9-7-,
Address: -3?,12 r5 o� t +t,
Legal Description:
Property Tax ID #: 2 6!, IR7 [W -5-Co GS 0000 ODO/OLot No.
Site Plan Name:/Block No.
Project Name: S�'dS O✓1G
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
Total,Sq.
d�'` � 1: i i
,Gost•i'.of C
.V.
Il. alrowN
Name
r !}j
Add'res.
_ Gas Tank
_ Plumbing
Ft;of Construction:
3ristruction: $ -T�1 Oov,
_ Gas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
rCify;_. I/eGQc75[L �i State:C•
zip`Coae: 3� °I b O Fax:
Phone No. -707;4 6--(65 L 53
E-Mail: l)ou,-, 4-1 (W 0 L(Col+ /vteCleti rCom
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: tom-•
Windows/Doors
_ Roof Pitch
Building Height:
SiLi 9%t'_e5 lgrnu
1�—Z
City: Ihl% QecCr, State: -F(.
Zip Code: S 2-q (o 0 Fax:
Phone No 'K)S0 S' D14R k
E-Mail ci(�-G q � t� ral�oO Ca>
State or County License eczc
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
NOW NS R ION LIEN LAW INFORMATION:
DESIGN ER/EN GIN EER:• _ 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:
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 Countyy 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
commencirA work or recording vour Notice of Commencement.
// O�A' An,
wner/ Lessee/Contractor as Agent for Owner
Signs ukFLORIDA
Yiig�re of Contractor/License Holder
N.G.
f1 n
COU vTY OFF 4;W NCB ✓►
COONa
CLY 1I ln�Y�
The f99ffgQ�ng instr enttwas acknowledged before me
The for oing instru ent was cknowledged efore me
1 20by
this_'81ay of
20J by
this day of
A/
(Name of pers n acknowledgin
(Name of person acknowledging)
rrrr�
(S ature of NotaryPub
a e of Florida)
(Signature of N ry Public- State of Hefide . ,� ` �rj1R
j.. B
Personally Known OR Produced Id tibn
Personally Known
OR Produced Identification
Type of Identification
Produced
° ; JOLENE K. THWIC
= �• SOU
IType of Identification _
produced - a
- r•o
Commission No.
= "� �My COMMISSION #FF07974
"'�;"' - 0, e X 59 December 29, 2017
] Z
ommission No. (A AV B00
(407) 39&0153 FlorldawtarySeNlce.com
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RE EW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014 /