HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: 1109-
RECEIVED
Building Permit Application SEP 2 9 2017
Planning and Development Services - .
Building and Code Regulation Division i' PERMITTING
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 f
PROPOSED IMPROVEMENT LOCATION:
Address: 30sr W, (4y-fs-be Ave
Legal Description: lZ1VGf_ PA*2V_- QQ%J- I - (bL-V- AD Lo-V C1
Property Tax ID#: 3y 19 -SD1- 01a1) -000-Z) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
$R%PL'AM MAta lbe,&A"W_ PA 06L,. L_tIG% FDf— L.dv,�r,
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 0 `v'al�. Utilities Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name kyioo 4 oLssso Name: ISI__ �L,�C�(L�CK�L S��VIC."cuS wT
Address: 30g W u%f A(U669- AVC: Company: rR0 6e'r O Qi�O��Ya
City: P S I__ State: ri, Address: %'YJ I O tZ 5-f L L)"6 W a—f ( tL%.b
Zip Code: 31ij5'l Fax: City: PGL- State: rL-
Phone No. 6QD /• Z & 1217 Zip Code: 344q% Fax:
E-Mail: Phone No. '3'D 3`I D l,3ls
Fill in fee simple Title Holder on next page(if different Jpym
from the Owner listed above) State or County License: l 3oc7a.3
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: Ad d ress:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Add ress: 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 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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
1
STATE OF FLORIDA 1 STATE OF FLORIDA l
COUNTY OF�� j(!,1F. COUNTY OF
The ping instr ent w s acknowledged before me The fo oing instruWtacknowledgbefore me
this day of 20ff by this day of 2017 by
Name of person making statement Name'of person making statement
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
Type of Identi}cation Type of Identtio
Produced Y L) Produced flu
fill
cy-- A
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(Signature tf�+�, u IK�1"*i$f.F�tMTN (Signature ofNotary P v- '- f¢hmidasl ion#FF 115637
3: �= Commission# FF 115637 '%''Eor.�o�P.'• My Commission Exp es
it
Commissio 1O My Commission "Ips Commission No. """"" J al . 201 8
"E ` June 12. 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17