HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA:
ALL APP BLEINFO LIST BE COMPLETED FOR APPLICATION 10 BE ACCEPTED
Date: SCANNED Permit Number: I N Irl
BY
S't. Lucie County RECEIVF:r)
Building Permit Application
Planning and Development Services L SEP 2 0 2018
Building and Code Regulation Division ��'Vll Q?Ynty, PgrjMVtting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial L,�— 'Residential
PERMIT APPLICATION FOR: To-Sel,ect from dropbox, click arrow at the end of line
Address:
Legal Description:
IPROVEMENT LOCATIO
Z,O, 3
PropertyTaxiD#: ��Sz-L— Z?
SitePlanName: SA�,� /�Z/4,
ProjectName: 94_1�1 A5�1111
Setbacks Front Back: —
DETAILED DESCRIPTION OF WORK:,, -
I 74�1
CTION INFORMATION:
Right Side: Left Side:
Lot No.
Block No.
ioitionaiworKtoDenertormea
11HVA
0
Gas Tank
unaer mis permit— cneCK au
E]Gas Piping
appiy:
M Shutters owindows/Doow
11 Electric
El
Plumbing
[]Sprinklers
F]Generator
L�Ra�o�
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:$
S Ft of First Floor: /�60 �—
Utilities"'12 Sewer 0Septic Building Height: 17 /Ii7�
OWNER/LESSEE:
'CONTRACTOR -
Name da
Name: PoC74�, Z5Za
_r
Address:- ;e712-Q Y A-
Company: �4
Xa
City: aev5t-c� State:
Zip CodePq S7 Fax:
Phone No.
Address; 3W,5' &z� 76'
City:.06Z,� 'r, 74
Zip Code: 3ZI9!� Fax:
Phone No.
Stat;��
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: gir" '3
State or County License: C6 c a,&:-3 �7
if value of construction is $2500 or more, a RECORDED.Notice of Commencement is required.
I
"-�-'U-P'P-'LE-M�-E-N-T-AL''C'-ONSTRbt-ribN�EiLN.LA'W�'INFOR'M'-A-TIO'N"*,
— Not Applicable I MORTGAGE COMPANY: — Not Applicable
Address: I Address:
City: State: I City: State:
Zip: Phone Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: —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.LucieCoun makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in co 171ict with any applicable Home Owners Association rules, bylaws or an9covenants 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 property. A Notice of Commencement must be recorded and posted c th J b ite
In e lo si
before the first inspection. If you intepOto obtain financing, consult7'th len7d ran��ybef re
commencim�� or recorc otfeNotice of Commencementr-%
Signatur r/ CesseL'-fContractor as Agent for Owner
ig6aere ntratfor/Ocense Holder
STATE OF FLORIDA
S F F ORI?
r5ci L
,
COUNTY OF
COUNTY OF
g
�2
The forgoing instr I ent was acknowleclg�d before me
UM
The forgoing instrument was acknowledged before
2 0, by
thlsO� dayof 2017 by
thisQX-dayof /qcu�J,/—
I S A
0
Name of persdn maki"t4ment
Name of person m staterne nt
r
Personally Known Produced Identification
Personally Known OR Produced Identifica ti
a
Type of Identification
Type of Identification
Produced
Produced
...
E a, 11101111
(Silinature of Notary Pug it # CIO J12`1
arphIP01 2&
(Signature of Notary Public- State of Florida
MY COMM,
I ';'F)
Commission No. t
Commission No. .(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE-.
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17