HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: S /� } Permit Nur,. „ " L
SCANNED
BY
St. Lucie County
Building. Permit Application
Planning and Development Services JAN 18 2018
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:
Address: /0 Z446 ,V w><a %/ / 0 7• Oo/>< c/ w c re it 3 91
Legal Description:
PropertyTaxlD#: 3y�� SOO"DI33-DOp�/ Lot No.
Site Plan Name: Block No..
Project Name: /%l�f ntJpr�
Setbacks Front Back: Right Side: Left Side:
Additional work to ,eperformedun ert ispermit—c Gc a ;t-atappy:
'. e, h
Mechanical ! ::- "•Gas Tarik i, Gas Piping = ',:Shutters) Windows/Doors,
a : -Electric. _Plumbing —Sprinklers —Generator _Roof
Total Scifl t of Construction: ,; So. Ft. of First Floor.'
Cost of Construction: $ a 0 q h Utilities: —Sewer _Septic Building Height: 70
Name J90ndal ) Nly�ap/tWon Name:
Address: /d 1il e IlAW f;,' / 0 "7 Company: Co a✓�.� �/ /Jc. n�J��
City: r)< ✓%l Lvc re State: Address: �/136J�. G�crc b�
Zip Code: ,� G�%S2 Fax:/A City: —�i` • �s'e% Stater
Phone No. c3 VO—� % zip Code: 3 y% yr? Fax: 77L=
E-Mail: 6 1. Phone No. 771
Fill in fee simple Title Holder on next page (if different E-Mail: rV P4 o ,r1,.I G g-
from the Owner listed above) State or County License: S' C C 13//S/SOo
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I EER: Not Applicable
DESIGNER/ENGMORTGAGE COMPANY: Not Applicable
Name: oa, 7 n
_
u CNTs7 o h Name:
Address: a[ Address: ,i i .
City: ry', /CP State: C City: State:.
Zip: Phone: ,2 C 7- 022 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name.
_Not
Name:
Address:
Address:
City: rCity:
VlY
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 priocto 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 ano 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
The following building permit applications are exempt from undergoing a full concorrency 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.
ignature of Owner/ Agent/ Lessee nature of Contractor/Ucense Holder
N
STATE OF FLORI N
COUNTY OF iv NTY OF
=ba
The far ing instrua n�t was acknowledge efore me f rgoing inst en was acknowledge efore me m �N
this dayof_`� y� 20 li mN 0 j�
Y . .. day of 20/by :
(//�
(Name of person acknowledging) y q( me of person acknowledging)
J11"a
(Signature of NotV Public- State of Florida) (Signature of Nota ublic- State of Florida )
Personally Known OR Produced Identification . Personally Known FOR Produced Identification
Type of Identification Produced Type of Identification Produced .
Commission No. (Seal) Commission No. (Seal) „x
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW- ..
REVIEW
DATE
RECEIVED
DATE
COMPLETED
! !�
Rev. 7/2014