HomeMy WebLinkAboutBUILDING PERMIT APPLICATION, AL
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �t�
Date: li" "SCANNED Permit Number: L g6-1, 0S t' 3
BY
. _ St. Lucie County
RECENED
Building Permit Application JUL 312018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 9C 6ucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Property Tax ID#: 3'6-5S- (QO\ �bID �C—b Lot No.
Site Plan Name: '9 ) 6'b 5d De • Block No.
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Project Name: ci-n 1 Qd A-3 -cr i
Setbacks Front Back: Right Side: Left Side:
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is permit� - �rcneCK aii apply:
_GeneratorElectric Plumbing []Sprinklers �q1I!,
0 Roof Roof pitch
Total Sq. Ft of Construction: Sqi---Ft.� of First Floor:
Cost of Construction: $ 3 t000 Utilities: Ftof
OSeptic Building Height:
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Name:
``
Name QV\ EewJat
Address: SC'1,i0 S • no -P_An 455%4
Company: Ap4Lir,\
City: aeD!3e,Il_7bA ef)n State: FL_
Zip Code: 3kr-A G /+ Fax:
Phone No. �(�1a -• (4 119 at. 81g
Address: _bno k e-
City: State: L
Zip Code: 3y9 q `4 Fax: 35%4— 1 OT g
Phone No. - D 1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail: I Q h i1�LdZk� fx�• t127t
State or County License: 5CC 15 t 1911 2(.a
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. Ito
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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 Count yY 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 andcovenantsthat 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 your Notice of Commencement._
as Agent for Owner
STATT�LORIDA
COUNTY
The r oing instrument was acknowledge efore me
this day of \ "1 I 20 by
weA 2m Py- Ael tW��L
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
(Signature of Nc
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
.16i
ommission # G
My Commission Expires
June 12, 2022 _
Signa re of C tractor/License Holder
STATE OF FLORIDA
COUNTY OF MCA_A�n
The forgoing instrument was acknowledged before me
this'L day of --To %'4 20_1'a by
Name of person making statement
Personally Known 4 OR Produced Identification
Type of Identification
Produced
(Signature of Nclqry ubllt- State of Florida
Commission Noah b�8b .ey, N %0liblic stale of Florim
`F Donna Jayne Hall
K.. a My Commisswn GG 207585
FRONT I ZONING SUPERVISOR I PLANS I VEGETATION SEATURTLE I MANGRU
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