HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE coru. -,'-�TEID FOR APPLICATION TO BE ACCEPTEL;
Date: Permit Number:
SCANNED
BY
St. Lucie County RECWED
Building Permit Application AUG. 2 9'2018
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie CountY
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Y"" Residential
PERMIT APPLICATION FOR: To Select frorp dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Aciclress:0�-) Rve
Legal Description:
Property Tax ID #: D9 IG - S31 - 0:7:� 0 Lot No.
Site Plan Name: Block No.
Project Name: -�;) Lbr-)�- Qcb*
Setbacks Front Back: _ Right Side: Left Side:
10
C,9,NST,,,CFTIONIN.FO-RMAT N:
1 :1
HVAC
L_-J Gas Tank
1:1 Plumbing
Construction:
iction: $ 1,37, c103
11E-cl
Piping
nklers
Utilities:
S ti
'h'U e rs'
G e tor
"t of Fi loor:
D e M —
S we"r _Septic
1. �� � � ,
-J Windows/Doors
11 Roof = Roof pitch
Building Height:
OWNER/1-8SLE:.
CONTRACTOR:
Name
C (i cc
J
Address: 2)0 V r,) )�)V:t
Company:
inc-
City: P;:tr State: K-L
Zip Code: 3DI) Fax:
Phone No.-�-,�a
Address: Is-59 S��
(2)
City: �A LaL0,P,-4ck1e-
Zip Code: 3?5'� 1 �i
Phone No. A-:Cp I - a?9
state: FL -
Fax:
- SS) P.
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail: )cnip-enmdin�
Q ��Qr\ cgh^
State or Cour�ty License:
6C �-�3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Address:
City: State:
Zip: Phone
FEE
Address:
City:
zip: _ Phone:
— Not Applicable
MORTGAGE COMPANY:
Not Applicable
Address:
City: State:
Zip: _ Phone:
BONDING COMPANY: —Not Applicable
Address:
City:_
Zip: —
Phone:
OWNER/ CONTRACTOR AFFiDVIT: Application is nerei3yMaUeIUUULdlildy=illllLLU�w%"�"w'""-
I certify that no work or installation has commenced prior to the issuance of a permit.
makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
St. Lucie Coun I 9covenants that may restrict or prohibit such
which is in conrlict with any applicable Home Owners Association rules, bylaws or an
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 4ouce Or k10111111cl
ucillati'.
'u
sWture of ContraCtoriLicense Holder
t of ContractorJ
e c or as Agent for Owner
Sign V e of owner/ Lessee/Contractor as Ageril Tor Owner
F
STATE OF FLORIDA
STATE OF FLORIDA
STATE OF FLORIDA
r
COUNTYU. Lb C-%'
COUNTY OF
The forgoing instrument was acknowledged befo S.2
The forgoing instrument was acknowledged before
me
this D9 day of 20 by
this day of 11 1 0
g
-1
CU
e S: F�SQ cj�.c
Name of person making statement
V/ OR Produced Identific
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w&'E E
ige,
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Name of per n making statement M .0 :�
�%�- S
Personally Known OR Produced Iden M20i - 9
Personally Known
_
Type of identification
r� Q'b �&
-1 ��- i 61
Type of Identification
Produced
9! r E t
a, E'5
Produced
Z
(Signature of Notary Public- State of Florida
(Signature of Notary Public- Stat of Florida
(Seal
Commission No. (Seal)
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
REVIEW
SEA TURTLE
REVIE W
MANGROVE
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17