HomeMy WebLinkAboutRevisions All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1
Date: q lc,�QPermit Number:
REVISION
_ APR 2 2 201
Building Permit Application
PEWAITrllyG
Planning and Development5ervices C,. L„c;� �o ,qty, Fl
Building and Code Regulation Division 4
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: . ����
P'Ii ,OR�SED!' �' R.®1/�IVI�ENTLOCATLQ�N:
Address:
Legal Description: G &aTznmE�+—Semd Adelo
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(0.3=0EL). CO c �)(0-7 -
Property Tax ID#: g`i:�l(0 06QO I cJoclo Lot No. V
Site Plan.Name: Block No.
Project Name:
\'r3ar)c� f-�na
Setbacks Front Back: ✓ Right Side: ✓ Left Side:
D �A'I!L=D D �$CRI�PTIO'N O� WORD ;
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"I 'man-, 1 � . � U "1610' Ond
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CONST �l1CT Q N'FOR .. TI®:N�
itiona wor to be pertormed un ert is permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 2 210 Sq. Ft.of First Floor:
Cost of Construction:$ c��V Utilities: _Sewer _Septic Building Height:
O +FSR/LENS`S� : ,. CO.NTR CFOR:
Name Name:
Address: , Company:
City:T�--P{crca State: FL Address:
Zip Code: Fax: City: State:
Phone No.--7), — (� 31 t D- Zip Code: Fax:
E-Mail: .RbOF,1,f Cb26-ShUel(='�)CV1Q0\S.0'Q Phone No _
Fill in fee simple Title Holder on next page(if different U E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENT L CONSTfi CTI.O .LL IE�MNWV. it=ORMATf�N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covehants 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
commencing work or recording our Notice of Commencement:
L lee
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � . LU C COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this @,�L day of 20_Uo by this day of ,20_ by
LAO P to,Y-MfkW 0 L7-
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification T o Identification
Produced KAREN S. NIEL uc
_� *, Commission N FF 115637
Commission No. — l— - �) My Commission Excbrnmi ion No. (Seal)
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
RECEIVED
APR 2 2PERMITTING
2111
5t.Lucie County,FL
Applicant has been advised NO structures (J
can be erected within any easement or 1
right of way unless otherwise approved.
Applicant initials—� --- {/
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