HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COIMPUEI-&� FORAPPLICATION TO BE ACCEPTED
Date: CN� O'A N. \k SCANNED Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
M T
St. Lucie CountV
RECEIVED
Building Permit Application
SEP 2 8 21018
ST. Lucie County, Permitting
Commercial Residential
I PERMIT APPLICATION FOR: C' *"k� I
Address:
Legal Description:
5 65-�' 0 0 2, - D 0 9-1 -
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front�'� �'d Back:_ Right Side: K%d LeftSide: // 6 c--�
Lot No. i
Block No.
—Mechanical — Gas Tank — Gas Piping — Shutters — Windows/Doors
— Electric — Plumbing — Sprinklers — Generator — Roof Pitch .
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
UON N E R:/,
Wo 0 N TM WA`G RT 0
Name—
Name:
Address:-
Company: —
City: State:
Zib Code:. Fax:
Phone No. rp--t
-A!�K
Address:
City: State: (1�2
Zip Code: 3,41 9W Fax: .7,ZQ MI
Phone No
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail 4xi C=a�'kes!� N A--,4 YAL a
State or County Licensea6�C J-2-J' M
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
- W E MEN' J'S�T _ 7QN�FTIE,
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DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: —Not Applicable
Name:
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 permit holder to build the subjecL structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and 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 Wce 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 recordingyour Notice of Commencement. I . I
Signature of Ownergessee/Contractor as AgVnf for Owner
Signature of CoVFactor/Licens& Ho d-O' I
STATE OF FLQRkDA
COUNTY OF --) -t %-.Z CIA,
STAT r4
-
Lozl*c�%�
The forgoing instrument was acknowledged before me
The 10 ing instrument was acknowledgel before me
th!0LA day of YA 20-W by
this-Nday of 20_t'f_ by
b %, _r 0 v,. 1-�k, vs� CS X-C—
% Itm v\
Name ofperson making statement.
Name ot �erson making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Iden
Produced—
Produced 4=2__
IA�
f Notary Pdo)lic- S I s
G
(Signature of N"-' —lca--RKkVd)vENs
'C MIS j6,2020
Commission No. D r
WMMISWON # GG 022023
S�. %CUna-
ommission No DIRES: D�mfggeJW20
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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