HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: i 3 Permit Number:
• _ _
Building Permit Application JAN 'i�
Planning and Development Services /`'� 2018
Building and Code Regulation Division
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: uqq nc ti -- sw -fm,—RiKae� iog
Legal Description: V int''� f I�I'Ve
Property Tax ID#:_Sg15—'/ oL,- 0005—DoLot No...
_
Site Plan Name: rr ^^ttpp Block No.
6�,Ubly I
Project Name: T�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC 11 Gas Tank ❑Gas Piping Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Constructi n: SFt.of First Floor:
Cost of Construction:$ �Q, V Utilitiesli Sewer Septic Building Height:_
OWNER/LESS.EE: CONTRACTOR:.
NamefSOhft YWCT-7, Name:
Address: UM V(CKIMS121V TEK Company:
City: f9 L State: Address:
Zip Code: 3qq Q 2 Fax: City: State:
Phone Noc. 2 U5— 972,5 Zip Code: Fax:
E-Mail: SAJ0WNAA P ram.um 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: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: P.}ione:
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 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 res'ult'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: !f you intend to obtain financing,consult with lender or an attorney before
commenc" ork or recording our Notice of C cement.
-signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OFV" ackCvl COUNTY OF
The forgoing in�,tr ment was acknowledged efore me The forgoing instrument was.acknowledged before me
this -day of ��
nU- 20-6by this_day of 20_ by
Name of.person making 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 Notary Pu ic-State of Florida) (Signature of Notary Public-State of Florida)
Commission.No.
`Pu!!an CH ARLOTT�SB€ 11*4E LANDIS Commission No. (Seal) _
.>>,aY o�'•%,
Commission# FF 984098
My commission Expires
's
12? April
c n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEWREVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17