HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED'FOR APPLICATION TO BE ACCEPTED
Date: _ \\ \J ` 11 Permit Number:
SCANNED
,T ', �! I BY
s RECER'7-D AUG 15 2017 St. Lucie County
-- Building Permit Application
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 Residential
PERMIT APPLICATION FOR: Reh�J q i *' n h
Address:
Legal Description:
PropertyTaxlD#:
Site Plan Name: i2A
Project Name:
Setbacks Front Back:
- �*0'2 - oo(Da.-
cob - Ca6 -
Right Side:
Left Side:
Lot No.
Block No.
_Mechanical _Gas Tank _Gas Piping _Shutters ,Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ EX"
"'e' ) 0
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
NameL-
Address: S 2'
Company:
City: State _
Zip Cod Fax, -l�7�� / 94/
Phone No. 11Z •9i2Q- IQ17i
Address: RI r �{-
City: ma
Zip Coder
Phone No aj y'..-1L�
Stater
Fax: �17Z•-L93-t4r9
1 -'0t 103
E-Mail: M &%A0 Q Q m o-i (' (A
Fill in fee simple Title Hold& on next p ge (if different
from the Ow_ner'listed above) , r
E-Mail ES. o 7
L(/L.•" Co M
State or County License
If value of'coristfuction is 2500-or'rnore,a RECORDED Notice of Commencement is required. 4ZA, JV ° `A `
I
SP-1 EMENTAL CONS CTION LIEN LAW INFORMATION:
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:
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.
Inconsideration of the granting of this requested'permi4,'I aoahereby agree'that I:will, in alfrespects; perfd"rm;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 our Notice of Commencement.
Sig"nature o�essee/C�as Agent for Owner
ESIgt re of Contractor/License Holder
STATE OF FLORIDA/
COUNTY AeV1
STATE OF FLORIDA
OF
COUNTY OF
The forgoing instrum�asacknowledged fore me
this day
The forgoing instru t was acknowledged before me
of 20 y
this day o� 20[ by
//
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// rr
of ers knowledging)
T
•(Nam of a acknowl ing)
Q
(S nature of Notary Public- State of Florida)
igna ure of Notary Public- State,of Florida )
Personally Known � OR Produced Identification
Personally Known _ L OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV E
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
YG Nota Publ
State of Florida
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DATE
COMPLET
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