HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,JL
All APPLICABLE INFO MUST BE COI4irLc rED FOR APPLICATION TO BE ACCEPTED
- 0 qO
Date:
Permit Number:
RECEIVEDOCT
QySer'm"pplicatior
2 2 2018
Planning and Development Services
Building and Code Regulation Division
St. Lucie COUI1t ST. Lucie County, Permitting
)I
2300 Virginia Avenue, Fort Pierce FL 34982
.
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial C/ Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: - 'go
'7 ^ 0O - Lot No.215_�.
Site Plan Name:
Block No. 9
Project Name:
Setbacks Front Back:
Right Side: Left Side:
v' (o Dc7 J
�+7i F�rPJ1J
Additional work to be performecl un er t is permit- check all that apply:
_Mechanical _ Gas Tank
_ Gas Piping' _ Shutters -Windows/Doors
_Generator _Roof Pitch
_Electric _Plumbing
Total Sq. Ft Construction: -iL�
—Sprinklers
�1 Sq. Ft. of First Floor:
of
o
Cost of Construction: $ fUflc' Utilities: _ Sewer _ Septic Building Height:
Name .c,
Name:
Address: la 'Z qQ- (2AZ41r,4n
z lg&j!� Company: a - G C^
City: 74M-t & i lr '
State:, � Address: /
Zip Code: 2�Fax:
City: /41.5 L Stater
Phone No.
Zip Code: Fax:7�-10AI-%90P
E-Mail:
Phone No 1414 2
Fill in fee simple Title Holder on next page (if different E-Mail _ C. &V$ /L'(!C /i/Cb na V,1.46,0,
from the Owner listed above)
State or County Llcense_Loi
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER; V Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: V Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: V Not Applicable I BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Name:
Address:
Zip: Phone:
Applicable
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 subject 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 concunency 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 vour Notice of Commencement.
Signature of Owner/ ssee//Contractor asA&6t for Owner
Signature of ntractor/Licens Holde
STATE OF FLORIDAL�
STATE OF FLORIDA CV
COUNTY OF Luc t E ,
COUNTY OF
The fo ling'instru nt as acknowledge efore me
thi 3day n - 20
The forgoing instru nt s acknowledg before me
this lay 20 by
of
I" JAI
�'by of �
(Name cif person acknowledging)
(Name of per on acknowledging)
(Signature of ctary Public- State of Florida)
(Signature of Notary Public -State of Florida)
/
Personally Known OR Produced Identification
Personally Known OR Produced Identification ✓
Type of Identificatio
Type of Identification
Producedrff""', KAREN S. NIELSEN
Produced RI I
*s5tateo oridadJotary.Public
Commis o�pn p- GG 207464
Commission No. Expiresommission
- ,;!'�n,, KAREN S. NIELSEN
;��.¢t_State o cF cy��1a-Notary'Public
No. - =
My CortlTF9 on
My Commission Expires
June 12, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS/,,VEGETATION
SEATURTLE
MANGROVE '
COUNTER
REVIEW
REVIEW
REAyl
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
5t/b
COMPLETED
fl
Rev. 7/2014