HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � �T Permit Number:
L �'o
S 11
- n
Building Permit Application NOV 2 12017
Planning and Development Services PERN11 i TING
Building and Code Regulation Division St. Lucie ounty, 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: 5 `iC `/ 13 C' Ur-
Legal Description: I-oc/lG --U/,ll-f' 09' - 8I K 96
1-0-F Z1 00 Of 7-2. (MAP 31/i2S)(012 2-42- 1 — /6/O
Property Tax ID#: 3402- - (b /0- D 4 1 - 00o - ] Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: sem, e f ;f s71
r
Replace- $<o+'-ed 604)j , Replace Plywood -Ploori ng , T11I
Nq��2GI +o s4-wds1 8pehNy viuils , every 8 i0641e'S ,/c454 174r1 cue /ncti r'o�'1 /3oFfc�
Titi
STRT'oo
N IN FORMATI "N:
onate er orme under t is permit-c ec a apply:
HVAC n Gas Tank []Gas Piping _Shutters ❑Windows/Doors
❑Electric ElPlumbingSprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: 600 Sri. -F S . of First Floor:
Cost of Construction: $ -9500 , 0 O UtilitiestSewer 0Septic Building Height:
OWNER/LESSEE: a CONTRACTOR: " `
Name /Z O's 0 i n I ,LCI KrGt vy) Name:
Address: 5 2 3 5 /V&J TC1 k-f, Ct Company:
City: Po r-I S t L U C i C• State: / Address:
Zip Code: 34Fax: 777- - 595 6,60 City: State:
Phone No. 772- - 2G I- 76 55 Zip Code: Fax:
E-Mail: Aoc;lreuo Ki,SSooN Q'3ol .GO Phone No.
Fill in fee simple Title Holder on next page(if different 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: I>Ci V D C-le-ye l cirn d Name:
Address: loo Ave- A Address:
City: For-i- pierce State: F I City: State:
Zip: Phone -772-- 4b4- 2UI o 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 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
befor the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co m ncing work or re ing your Notice of Commencement.
Sig ture of Owner a ee/Contractor as Agent for Owner Signature of Contractor/License Holder
STAT F FLORIDA STATE OF FLORIDA
COUNTY OF .S+• I-U 6 i a✓ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z l day of Noyem,ber 20ff 7 by this day of 20_ by
905i'lini �—uk:KC4YVl
Name of personfnaking statement Name of person making statement
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notar atA ddIFA' ik�r� (Signature of Notary Public-State of Florida )
My Commission GG 98009
Commission No. U D�P"�sos/ 3/m Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17