HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -1 AS- vs Permit Number:
SCANNED
BY RECEIVED
St. Lucie County
Building Permit Applic tionApR `L 5 'r018
Planning and Development Services
Building and Code Regulation Division - ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATIONFOR�F Gatg1� aaac
Address: _\ 'L FTZ a gg� )CA=�1 !!��
Legal Description: C\� \C1GtY f�V% �=lY, �ra _ . P'
PropertyTaxlD#: -tea- 60�--�-LI Lot No. �
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
3` ` C:��ca� d�
wivpIIClJU[WIN nvt-VKIVIHIIUIV:
Additional work to be nertormed under this permit - check all apply:
❑HVAC Gas Tank ❑Gas Piping _Shutters
❑Electric ❑Plumbing []Sprinklers❑Generator
Total Sq. Ft of Construction:
Cost of Construction: $ tcc)
S Ft. of First Floor: _
Utilities:❑ Sewer []Septic
EWindows/Doors
❑ Roof ❑ Roof pitch
Building Height:
0,1NN ER/LESSEE: _
,CONTRACTOR:
Name �GL'CC. S
Name: Cs- 'A�Y�
Address: \Cc:�-la.( S flC�Zj• � C
Company:) cC o S V pst-
City: SC1 r `�Xfr� State:
Zip Code:7 Fax:
Phone
Address:4a5
City: V?,�A- If State: FL --
Zip Code_.�q%lo Fax:
Phone No.L41,�-fib J
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail.. �+r�a n�/ C� C�C� CiC7�f aCtr_ css5P0•
State or County License:
if value of construction is gzsuu or more, a RECORDED Notice of Commencement is required.
\ie f
SUPRLEMENTAL
mow'.-:
CONSTRUCTION LIEN LAIN
..�.. 8
INFORMATtO1V
..
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
commencini>_ work or recordine vour Notice of Commencement. C
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Li nse Holder
STATE OF FLORI A
STATE OF FLORI�DQ
COUNTY OF\C
COUNTY OF i�ucC�
The forgoing instr ent was acknowledged before me
this V day of i i 20 (% by
The fprgoing instr ent was acknowlecigGcl before me
this l`e day of ff( by
\20—I\,S,
Name of persoaking statement
Name of person making statement
Personally Known ✓✓n/nOR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
C�SV_a 4.9—
A
(Signature of Notary Public- Ytate of Florida)
(Signature of Notary Public- Stake of Florida )
.eT.:Ode" TIFFANY A. LEE
Commission No. ������ � segJEXPIRES:I0NIFF1014,4Commission
t
"iky Py
No. FFI�\�1� �° �Se II11 71FFANYA.LEE
EXPIRES:Apri126,2010
Bonded Thru BudServi
EOFfLO 9etNorer Y
* .�7t00•ti11SSI0fJOFF 101
EXPIRES: April 26, 201
:s �ew"3?p
BondodTIM Budge: Notery sery
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17