HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
j
Building Permit Application JUN 9 6 201?
Planning and Development Services
Building and Code Regulation Division P E R F0 I 171 NIG
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential �
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: C?619 QrLjoe'k C_-T C_
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: be-t
.5" Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
"d e-
2-,0-- 2-(f,
CONSTRUCTION INFORMATION:
Additional work tobe nartormed under this permit-check all apply:
EIHVAC 11 Gas Tank E]Gas Piping Shutters Elwindows/Doors
nElectric ElPlumbing OSprinklers E]Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Z
Cost of Construction:$ _3 Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameAl<o_0 :Qe_v-,e_ Name: L.?tv's
Address:!?6/1 c;+- Company: -'i�';A&_rs
I
City: qor� s-+ Lo"-p— Stater Address:32-31 6C 'hpy"�
Zip Code:,34 CO. Fax: city: 4- State-T(.
q Z-,&- g o&- /(__ -L IcL I Fax:
Phone No. ID Zip Code: 3�
E-Mail: Phone No.')-)2- 'D
Fill in fee simple Title Holder an next page if different E-Mail: C-b'q
43
from the Owner listed above) State or County License: SL-C- 0
C_ Sd
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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 thepermit 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
commencing work or recording our Notice of Commencement.
s
Signature o wner/Lessee/Contractor as Agent for Owner Signature of Con Tactor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 114,ft7m' COUNTY OF MRA'Ti,y
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this4y1 day of XuaC 201'7 by this Vt t day of 7uiy ,20 l7 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) `�\\pipItfm
M��� DELLA
of Notary Public-State of Florida)\\`\\\\\1`
Personally Known OR Produced Ider fic MMly 8 '•.Jf�isonally Known x OR Produced Ic�tptTitifi• ' ••y Co�59�
Type of Identification Produced *: ,, .Tye of Identification Produced
• $ Yso
Commission No.FF J.57 S`1 (S ; #FFIS ;Sjomission No.FF IS-7541 -A*al) •. ,75
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Revised 07/15/2014 ���SrATE i�\�```` /'�i,���••.....•�pQ�`
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
COMPLETE
INITIALS