HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE.',S' FOR APPLICATION TO BE ACCEPTED
Date: 7-(Zt �) S Ncl Permit Number:
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x s��NFt. RECEIVED
Building PermiPApplicati n FEB 21 2018
Planning and Development Services
Building and Code Regulation Division tNj ST. Lucie County, permitting
2300 Virginia Avenue, Fort Pierce FL 34982 U� C/ /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial . Residential
PERMIT APPLICATION FOR
CO
�,RQP-6 "01NPR0UEMENT LOCATION
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Address:;>i 170 " 3� go
C . n %
4Cr.
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R, 344
1 Q0
Legal Description: Ct,
h
Site Plan Name: AGO nG
Project Name:
Setbacks Front Back:. Right Side: Left Side:
Lot No.
Block No.
[Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors
,ztlectric -/Plumbing klers _ Generator Roof Pitch
Total',Sgi F.tiof Gor>rstruction: O 5 Sq. Ft. of First Floor: H 000
lQCo'st:ofxG'onsfructior� U O Utilities: _Sewer _Septic Building Height:
ER/k 0� !1 1 '
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GO�1T_RAGTOR g
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34
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Name" � �C�T ... LL(—
ifVame
Address: 2-2'I Cann' S i��
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Company:. vv-\ w Ir
City: �QS� . �� M ECG , I
State: FL'
Sddress: 2�0o
City: 1P,src-0 Siate:±(.
Zip Code: 33Y0ax:'S`i'ol (,41 o-71
Phone No. $(ol (c I O '$02 0
Zip Code: 3 f Oi �iJ Fax:
Phone No 7 a Se I I
I,QlMail:G1R\ )Q-Yl .(D (Z of . (.o�
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Fill in fee simple Title Holder on next page
( if different
�Statei,or,Coiirity;License{.�C oSZ lob
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
�'.
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not _Applicable
Address:..------ -
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
- -
BONDING COMPANY: _Not
Name:
Applicable
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.
IF 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
improFncilnw
is to ur property. A Notice of Commencement must be recorded and posted on the jobsite
beforerst i pection. If you intend to obtain financing, consult with lender or an attorney before
comm or recordingour Notice of Commencement.
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Signatu a of Owner/ Lesseet/Con2ra`ctor asTAgentfo�wn�n
f ".Sigtu[e of,=Contractor/License Holder
STATE OF FI,QfjIpA ,
STATE OFF IDp
,2
COUNTY OF �"Clim 'i J2Q�
COUNTY OFWW1
The fo oing instrum nt was acknowledge before me
this � day of � ru nn s . 20� by
'The forgoing instru nwas acknowledge before me '
this day of ��rrka.20 �6 by
_�
Q
Y
(Na a of r on acknowledging)
(N me F p rs acknowledging) '
(Signature of Notary
tateofFlorida-(SignatureofNotaryPuc-StateofFloridaPersonallyKR
7Publi
Produced Identification
Personally Known ,/�'`"_OR Produced Identification
Type of Identification
Type of Identification
Produced •"'�w"'• MUM LLE A. ROBRAILLE�
roduced .
_ ',- MY COMMISSION#GG 077751
�'""'"'• DANIELLEA.RO6ITAILLE
zy. "'•�::, -
�mmission No. b, ,(9Ba11jtES:June 26,2021
�ti •.,p Bonded
ommission No. MYCOMI(7S>�N#GG077751
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U`% % / � / ;'P' Thru Notary Pubic Underwriters
07EXPIRES: June 26, 2021
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Bonded Thni Noteiy Pu6Nc UndW0Lre
REVIEWS
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SUPERVISOR
PLANS
VEGETATION .SEA
TURTLE_
MANGROVE
COUNTER
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REVIEW
RE IEW
REVIEW
REVIEW
REVIEW
RECEIVED
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DATE
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COMPLETED
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