HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETLu,JR APPLICATION TO BE ACCEPTED ^
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Date: / �,._11.Permit Number: 1� a� 0� os
SCANNED
- BY RECEIVED
s
St. Lucie -County '
— -- — Building Permit AppliC tiodAN 18 2018
Planning and Development Services 5T. Lucie CauM, Permitting
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:e
PROPOSED INPROVEMENT LOCATION:
Address: 5'ta
Legal Description:
Property Tax ID #: a JQ�1— 000 — 600 Z67 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
r/N i7�iAtiL IJ w�+.� r vJb T.Qrv�/ �. W.c.af Fit�7J
_Mechanical _Gas
Tank
_Gas Piping _Shutters
_Windows/Doors
Electric _
Plumbing
_ Sprinklers _ Generator
_ R of Pitch
N� W
Total Sq. Ft of Construction:
N
Sq. Ft. of First Floor:
Cost of Construction: $
j ®0Z2 ft
Utilities: _Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name -:1"e5epl7 C. H/
a N
Name:
Address: b dM. �(i f/`
Company:
City: CF JO/lug F(r State: Pb
Zip Code: 3 5/ 9Y 7 Fax:7 7z4&tj' — 7
Phone No. %72 " 1/9-f 2 L 27
Address:?. J
City: State:_
Zip Code:- Fax:
Phone No
✓
E-Mail: r(�Jy �/ �6 prima �1' b/�✓r
Fill in fee simple Title Holder 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 required.
SUPPLEMENTAL CONS
C il, NNIEN11MINFORK000,N:
DESIGNER/ENGINEER:' '
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
'Name:
Address:
Address: f n
City:
Zip: Phone
State:
City: Y7 State:
Zip: Phone: '
FEE SIMPLE TITLEHOLDER:
Name:- .i i:;r eLc (e_
_ Not Applicable
rw.rR r 2 •
BONDING COMPANY: _Not Applicable
Name:
Address a 9�c G„
16 r
Address:
City:
City:
Zip: -i cfs� Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Ap�lic6JAn! hOe4
AhLde
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
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
commencinga work or recording: vour Notice of Commencement.
Signature wner/ Lessee/Con actor as Agent for Owner
Signature of Contractor/License Holder
STATE FLORIDA
STATE OF FLORIDA
COUNTY OF S f . J L1,04' e—
COUNTY OF
The forgoing instrument was acknowledged efore me
The forgoing instrument was acknowledged before me
this day of c r 20by
this _ day of . 20_ by
G M-i
- I
(Name of persok acknowledging)
(Name of person acknowledging )
/
(Sign: re of Notary Public- State of Florida)
(Signature of Notary Public -State of Florida )
�
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
�r0i'GO �a9mano
Produced
Commission No.y S'mfSg yJirO{�OLVd ,
GG� �39�i1
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
/r
RECEIVED
I
0
DATE
COMPLETED
Rev. //2U14