HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONt. N
ALLAPPLI AB E INFO MUST BE COMPLETESFOR•APPLICATION TO BE ACCEPTED - O ^
Date: I� zOl� SCANNED Permit Number: U
BY
St. Lucie County RECEIVED
Building Permit Application APR 2 4 2018
Planning and Development Services
Building and Code Regulation Division ST. Luele County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 �.e1
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
PropertyTaxlDft: 14�.S- GDS'- 0066 — 0 0- 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
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HVAC Gas Tank 0GasPiping
Electric Plumbing Sprinklers
Shutters Windows/Doors
Generator Roof = Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ✓i QQD Utilities: []Sewer 05eptic
Building Height:
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Name
VName
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Address: he, 70f)�/
Company:
City: / State: _
Zip Code: 5419V9_Fax:
Phone No.
Address:
City: ) A LI . State:.
Zip Code: D _ Fax: 3 -SS'�� a7 G7
Phone No. f1r, - - ! 4;Z
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Aq,_o,(A
State or County License: %� t✓ o 9 O �27-, S
If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable _
;MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address: _
City:
Zip: Phone:
State:
City: State:
Zip: Phone
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 thatis 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 cbncurreocy rbvtetNxoomadditions,
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
as Agent for Owner ;
:ense Holder
STATE OF FLORIDA STATE, OF FLORIDA
COUNTYOF �24--. Ltr.r j� \' `� COUNTYbF-1' Jr/l)/}ti 1%
The forgoing instr ent wa acknowledged before me
this,t� day of-g;� j , 20%by
N e�4tt of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notar ic- State of Florida j
io �...,.rb _ _GLENNROIiMAN_
Commission No. a :'i+�t'C MISSIONj6@B9)3168'_
y ES: October1,P019
�rEMnoe`Bo�.re ihry nutleetNotarySen'it6
The forgoing instrurwrit was acknowledge before me
this .4L day of A U I L 20-LL by
LtIJ& FA600nD
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
REVIEWS FRONT ZONING;—. SUPERVISOR PLANS VEGETATION SEA TURTLE': -`MANGROVE
COUNTER REVIEW.' ':`.REVIEW I REVIEW REVIEW REVIEW REVIEW
RECEIVED I -
Rev.