HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:SCANNED Permit Numb
BY
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 X
PERMIT APPLICATION FOR: Window/door
Address:
Legal Description:
Property Tax ID#: — 3y 19— so 1—
Site Plan Name:
Project Name:
Setbacks Front Back:
REPLACE (1) 10 X 12 ROLL UP DOOR
Right Side:
e errormea unaertnis permit —ci
_ Gas Tank ❑Gas Piping
ElPlumbing 11 Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 2205.00
Left Side:
I�03�nra1
RECEIVED
MAR 2 3 2018
ST. Lucie County, Permitting
Residential
Lot No.
Block No.
Shutters a Windows/Doors
Generator E] Roof = Roof pitch
S Ft. of First Floor: _
Utilities:"n Sewer ElSeptic
Building Height:
OWNER/LESSEE: 4°' # ""
x;CONTRACTOk` °
41
_Name
Address: (�laxlge �lG.
Company:_'�)i Z� Gcx ' cte,
1_1>� PSG
City:`i� Pve�G State: FL
Zip Code: 3ygLF1 Fax:
Phone No.-11_--1— QC(3— Otocaln
Address�:y f-JW Ervcxp,-
Gc_ �
tKX
City: k Sir L,_\�ci c—
Zip Code: 3 01L Ztv Fax:
Phone No. L4UC)—il0_240
State: FL —
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:r i Q( (Wj px_
Aoas A ,cc
State or County License: 00--1
it value or construction is>zSuu or more, a RECORDED Notice of Commencement is required.
v
SUPPLEMENTAL COfVSTRUCT10N LIEN ,LAW IN�QRIV[ATIOsN
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:
Name:
_Not 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.
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
commencin¢ work or recordine vour Notice of Commencement.
Signature off Own�ee Contractor as Agent for Owner
S nature of Contractof/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF S�
COUNTY OF � Lsc i ir_
The for oing instrument was acknowledg d efore me
The forgoing instrument was acknowledged before me
this day of� 20� by
this day of �C,t�C� , 20ATby
Name of person making statement
Name of person making statement
Personally Known I," OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�.Q
(Signature of Notary Publi - State of Florida j
(Signature of Notary Public- S to of Florida j
_ TiEFANY.A.1
-Commission No.FF��\y1C%1 Sgal)`iCO'Ia9SSIMPFF10144CommissionNo.FF�'C1\�{1
..-_ --_ � '��- T1FANy71:[EE`
al,I,jC0171"SSIONwFF1pt
a�w4p EXPIRES: April 26, 20U
X`1 EXPIRES: April 26, 201
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a 0� Bonded Thru Budge:Nourys-rv;
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN
EGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVUE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
(l8
Rev. 8/2/17