HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `�' 1� Permit Number: ( r0q
RECILIVED
•
Building Permit Application NOV 0 7 2017
Planning and Development Services PED!AITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
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: 12455 (7VUYull'y OO wAY Pori st uXAC f-L S'H
Legal Description: TY omirf w $- (SII (Aff=t Qt ai arb im Pori or �:ec 24 -�1 3o
ME frOVIA SF [Or nF L01 M Of tY SUd (Mf MUM fzun Oq
Property Tax ID#: 4224- 501-0061 -1 00-9 Lot No.�
Site Plan Name: Block No.
Project Name: H-f, V l fprd
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
15 ) 1 ;. Itaro -Ff-- Reroo-G -6hirgits vStnq 30( b re-_ I �
Cob ra 3 r,4f \)e.r)-+ S h( r'1 oS
CONSTRUCTION INFORMATION:
Additional work toe e Orme under this permit-check a appy:
HVAC Ei Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: 2)sA 3 S . Ft. of First Floor:
Cost of Construction:$ - 15� _ Utilities:In Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 11^h0 Ycl :H-r rY I f:prj Name: Jesus J11'►'11 ml'
Address: 124c.)5 (2ruryiYlAotn UjLA)t Company: JJ QUQ litf &MLIr5
City: ?oft st LUGS e State: *FL Address: Z-1S4 l Sl PI
Zip Code: X461 Q"1 Fax: City: tl Dwf"f '}CncI —State: 'FL_
Phone No. 140(0)223 - 2 0 5 Zip Code: 33D32- Fax:
E-Mail: Phone No.(5(o I) 555-(p204
Fill in fee simple Title Holder on next page ( if different E-Mail: 1 rtf0 3Jq ualitY dui Ir�rS�b. Com
from the Owner listed above) State or County License: GCG 126
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing workVr recording our Notice of Commencement.
s
Signature of 0 ner/Lessee ntractor as Agent for Owner Signa of Contractor/ ' nse Holder
PA,L-M lbEAc U
STATE OF FLORIDAII STATE OF FLORIDA
COUNTY OF �ICI4ALD 4U1_1F0e_D COUNTY OF P4LM (SjE4Cl-I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 31 day of OCT'4$EjL , 20 17 by this 31 day of OCT06EP_ 20 17 by
1 _1 IC144e_o 4E-" I FO 0—D JG506 JIMEN EZ
(Na a of person acknowledging) (Name of person acknowledging)
U V'a_� ,
(Signature of Notary Public-Stat Florida ) (Sig ure of Notary Public-State of Flori )
Personally K OR Produced Identifi ation Personally Known OR Produced Identification
Type of Iden ificat oc�;Proc� p 1 8 IS Type of IdentPic Xiowo,Produ�eAtCommission N ` My COMM ISS ION(Si$"70599 Commission 7`� _ My COMMISSiON(8La@4p0599
01 rl'7. S January 13,2018 EXPIRES January 13,2018
�- 998 0153 Floridallo R ' FI r-r
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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