HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i•
Building Permit Application DEC, r i Y01B
Planning and Development Services
Building and Code Regulation Division pet�0Perpnent
2300 Virginia Avenue, Fort Pierce FL 34982 / Cpagit1'
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Legal Description: S e o ""1k a d
PropertyTax ID #: a i' 4 - .5-0 I - Lot No.
Site Plan Name: SQN0u'tr10_. (2jL ) (+oa Block No.
Project Name: IQ Caen ha- CLLdf� for
Setbacks Front Back: Right Side: Left Side:
Kep Ic�..� e.,ct s�►-r n9
PVC
11 Electric
0 Plumbing
)CANNED
BY
St. Lucie County
Windows/Doors
11 Roof
Total Sq. Ft of Construction: Sct, of First Floor:
Cost of Construction: $ 145 %5'� y Utilities: Sewer Septic Building Height:
Name ' .VC4-)(10. C.)U_Ap &A'
Name: CFIc`'+-ifJ' 4iicX)M9-neL,
Address:349a Il(-
Company:S�tk 4 h2r\c.e- 0-0M
J? n t f
City: POIrF-si" L_u6[e State: fLLL
Zip Code: Fax:
Phone No. 'i'70 -o10I - to w q l
Address: 100 iJCri� �/o3I0
City: '54_r +-
Zip Code: Fax: 77a-a
Phone No.-7*7a-eR?e-III /
State: -
8g-303S
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:Abel (
Sou.+h . n of
State or County License: 20917S'
If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
V
DESIGNER/ENGINEER:
Name:
_Not Applicable
MORTGAGE COMPANY:
Name:
✓Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_ of 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 Counter 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 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 on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencingwork or recordin our Notice of Commencement.
4z% ✓ I
czd::�o
Signakirre of Owner/ Less a/Contractor as Agent for Owner
Signature of Contractor/Lio , se Holder
STATE OF FLORIDA
aX-Lk
STATE OF FLORIDA
COUNTY OF (Y Vl
COUNTY OF V- _
The forggqing instrument was acknowledged before me
The forgging instrument was gcknov�'ledged before me
this
P/�,CC.XyI K1 M 26V by
this 4±1'day o CAAnnkA Lr , 20-aby
,�'�fary�off.)7
(1 p �f L1Lt - �i GL}1 WL(9-vt Gi
Q_kp'-,Ye-V !'�lLh rll 6 d-
Name of person making statement
Name of person making statement
Personally Known ✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produceddj
Produced r J
(Signature of Nota -
(Signature of
Dir Pi,hiIr-�,tnfe of Florida)
'"r'° DIA y7�� BOND
Commission No. `' ll�fON #FF785430
Commission N
DIANE ?( BO D
.!!°�`:- ,,CCQQ''II
185430
I CO
"or M1°aF F.XPIRESDecember28,2018
1y ; + MMISSIOFfXfF
�PIRFS December28,2018
ce.com
c c
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 1 4