HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONle__ -*No
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:'OA I am SCANNED PermitNumber:
BY
St. Lucie Count\ -RECEIVED
moo S P 2018
Building Permit Application SEP 2 4 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie cou!��yt±crTlttinl I
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
Address:
Legal Description:
Property Tax ID i
Site Plan Name:
Project Name: fill-fto-5 e?
Setbacks Front Back: _ Right Side: _ Left Side:
Lot No.
Block No.
315�, 318,3 I.A) -316" 31'T' -3//t,-3/ a, S/7- ztl% 4,/B/ 4 1?, Zticj 'WJ_
)2_1 TIP., _5//G/ 5 V; V4, 51 9/;q/ e14
&F, la 14,, C 7/71 716, >W;�� �/'6,
06
M.
�-P, N '_IATON*
AaamonalworKTODe-Pertormed under this permn- cneCK all mnapply:
0HVAC LJ Gas Tank Das P1. - LiShutters E]Windows/Doors
UElectric 0 Plumbing OSprinklers 11 Generator 1-1 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:
S Ft of First Floor:
Litilities'll Sewer E]Septic
Building Height:
EE 4<6
A H
A-
C NTRACT
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Name ��5
Name:
Company: &bA_e:_(f6c;yL6�
Address: eZIT59- Q-7- )yzAJA&f_-- C,7-
Address: /O/J_�g Oe,' F b94
City: .66&2T
Zip Code: Fax:
Phone No.
State:
City: State:.�
Zip Code: Fax:Z�2_- 2974-5-344
Phone No. -z- -w-zq -
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ML-e, (Z,27ao � c, ;�-,> <52 ftA / L-(::xbA
-
State or County License: 4��6t C_
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
FA
119 CTI
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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 Coun makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is In conl7act with any applicable Home Owners Association rules, bylaws or an9covenants that may �estrict 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, wails, 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 0 obtain financing, consult with lender or an attorney before
Y=d
commencing work or recording otlilce of Commencement.
Signature of s ontractor as Agent for Owner Signat older
STATE 0" A #TE_Q"LORIDA
COUNTY OF 6 . s"J )UNITY OF S 4 - _"-� % -Q,'
The fo Ing instrument was acknowledge beforeme
this 2-Tclay of 20 *
_�j by
Name of person making statement
Personally Known — OR Produced Identification
Type of Identification
Produced lb L'
1) lx_�_ �-�
(Signature of NotaryYublic- State of Florida
Commission NoLE
REVIEWS
FRO
COUNTER
DATE
RECEIVED
Rev. 8/2/17
GM—M MARIE GIVENS
My COMMISSION 9 GG 022023
EXPIRES: De�rnbef% 2020
REVIEW I REVIEW
The forgoing instrument was acknowledgel before me
thlsl�4 day of S�QA 2d\ I by
Name of person making statement -
Personally Known OR Produced Identification
Type of Identification
Produced !E A- lb L_
(Signature of Nota
EANNA MARIE GIVENS
Commission No.
JIS 02.2023
MYCOMP 1!%
Vic
PIRES: Ditabe 16.2020
a-ded TI- Notary pubFic Unday',
PLANS
VEGETATION
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