HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE�,WO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:M-egao
BY
RM R.1 a 10 St. Lucie County RECEIVED
Building Permit Application SEP 2 0 2018
Planning and Development Services
Building and Code Regulation Division ST. L-14cle CoLinty, Perm
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
I PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
- Z-13/- 0001- (300-
qr�l alle, atllev�s
Lot No.
Block No.
Project Name:34moj 4b A6� p�(Ve!-j-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
7,,b -P a septiftew.
I CONSTRUCTION INFORMATION: III
HVP Ga s Tank OGas Piping [:]S'h*u ers; Elwin
�S/boors
f I Roof pitch
Electric Plumbing []Sprinklers Generator [�Roo Fz- I
Tota I Sq. Ft of Construction: & C?,x S Ft of First Floor: /0 C/ 0,
Cost of Construction: $ )? a�^ r Utilities"n Sewer ElSeptic, Building Height: _1_L&_v
OWNER/LESSEE:
CONTRACTOR:
Name,'3/1,�,�/
Name:O�sl�-- 0-l'bT ;-r T
Address: -7z12_ 431 S OC r-,52.—
Company: AOT/all,4V1111' -111-Al /W/f/
city: State. L
Zi p Co de: r7S,-,� Fax:
Phone No.
Address:J-/2S 151� 7jY
City: 1",14 r, ef stat;.7F:
Zip Code:5Z19e7' Fax:
Phone No. - 77 2-
E-Mail:
Fill in feesimpleritle Holderon nextpage (if different
from the Owner listed above)
E-Mail: roa4r4eA�r�afli 9 al 5! m v
State orCount'y License:
if value of construction is $2500 or more, a RECORDED Notice of commencement is requirea.
SUPPLEMENTAL CONSTRUICTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
—NotApplicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_NotApplicable
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anN 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 propert A N t' f Commencement must be recorded and posted on the jobsite
before the first inspection. If ) 0�
1�y�jnadeo btain financing, consult with lender or an attorney before
commencinlr'��orrecldrdina ur Notice of Commencement� Z 11�'
--S�ignatu�,4�Wner/'I�-essee/contractor as Agent for owner
-Srg-nature ntractor/Lic6nseHolder
=OF
STATE OF FLORIDA
FLORIDA %
COUNTYOF 92&4 It-
COUNTYOF
The forgoing instru entwal cknowledged before me
The Ing instru edged before la
,;nent was acknowl
2(W
this?-<' day of by
this _dayof 1�115ufl- 20ZY by
Name 6f person�m statement
gs'
Name of person Ing statement
��MOR
Personally OR Produced Identification
... ....
Personally Known Produced Identificati
Type of Identification
Type of Identification
Produced
Produced
Y711CKY CAR�L COCHRAN
lo'y YC 0 H
P 'c SO
Pu lic - Slate of Ffrlf�
Of IeCr Ffrx�'f�
(Signature of Not
(Signaturrof Nota -1- ON
RICKY CARL COCHRAN
Commission No.
Commission No. Notary Putil 0 a
commiss! 172136
, -MyCmnExpkVApi26,2022
.. . .......
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Rev. 8/2/17