HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPL ED FOR�1pPlifAi"' TaBE' CCEPiED
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Date:�0 U•3�1X PrmitNumbe
JUN 0 6 Z018 ECEIVED
- - ST. Lucie County, Permitting
woo Bu ing ermit pp ication 018
Planning and Development Services SCANNED fsT:,Lucie County, Pe itting
Building and Code Regulation Division BY
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie gib t
Phone: (772) 462-1553 Fax: (772) 462-1578 Comm dnl y Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: L S�r(� DnL�+"?}n/ fir /d/ D %C/VSEN�E)gr w 3 ;;, 7
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Legal Description: ]5?AWdZ t A— S -4"o
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AZ,%) 1, p YET 7 w&rs d- W �i✓ 5
_40-r Al'"
CONSTRUCTION INFORMATION:
Aclaitionalworl(t0yejerrormed un ert ispermit-c ec a apply:
11HVAC GasTank ❑Gas Piping _(Shutters Windows/Doors
Electric ElPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SQL FFtt,I of First Floor:
Cost of Construction: $ 3 W.) Utilities: I lSewer ElSeptic Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name 6/r..r.J
Name:—, — 12YA7Vme f e
Address: Pnz f:046* AwJ Oct-. /0/0
Company: L}* f�� /ZdGiibiJ
City: ./'. z • State:IFf
Zip Code: 3Y'kf7 Fax:
Address: 1/o7M l/.AJ- +A. 0%" b,
City: LoYd!/dfzree State: -
Phone No.
Zip Code: Jut 7- d Fax:
Phone No. J-4 I- GG O —3 f0 5,
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Avail: �DiiGoi✓tf/1�LI1O�✓//� C` `i�u�/` �^ t
State or County License: It Z /.C74{
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW, INFORMATION: -
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto 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 covenantsthat 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
commencing work or recording our Notice of Corn ement.
ignature of Owner/ Lessee/ContractghrAgent for Owner
ignature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
ATE OF FLORIDA
COUNTY OF S't '`✓t @
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thiQ1 dayof �AV9e,-/ 20ff by
this LZ day of !'t .20Wby
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AvV vvt �(S
Name of person making statement'
Na a of person making statement
Personally Known OR Produced Identification "0'
Personally Known — _-�OR Produced Identification
Type of Iden 'fi
Type of Identification
Produced
Produced
(Signat r
-
(Sig u Ic- tate Qf EE��pr�
STEPHEN S �yEL.T Ill
Com si
°°'� STEPHEN S gELTON.
eTOO.'k "=. (Sear)
Com zissi No! My COMMISSION#FF170Jg6
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^fP'COIRIOIISSION #FF770384
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• • C�:: EXPIRES November 2, 2018
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EXPIRES November 2, 2018
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REVIEWS
SUPERVISOR
PLANS VEGETATION SEATURTLE
MANGROVE
FRONT
ZONING
COUNTER
REVIEW
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Rev.8/2/17