HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:St 0 aid
J _
RECEIVED
JAN 12 2018
Building Permit Application
Planning and Development Services 5T. Lucie County, Permitting
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 3101 'S i-k_ R-Di e 2 5 L l"1, 31V. -S L
Legal Description: I (A3 lC S Ar :54 VA jjkjA 4[ ut� L.k l_0T
Property Tax ID#: � f300- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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T J �-v►.,,6 v� 4�J �-r_ -�C� ��rt-w(�-t�`-S D�v � l 1 �_ �-�-���-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: �L;'Do Sq. Ft. of First Floor:
Cost of Construction: $ �6 IS7)• Utilities: _Sewer _Septic Building Height: \\ 5
OWNER/LESSEE: CONTRACTOR:
Name /-�c_&tJ 4 Lzj= i-ww"A !D 'J tS Name:
Address: 3(01 It( Aa C.t:5-`DrL Company: elks-yoh � 1`—
City: 24�fi Stater Address: 32-71
Zip Code: ;qSS 2 Fax: City: lNe-e� Stater
Phone No. 2- y3(aC(0i'S' Zip Code: 7L Fax: 7 1-
E-Mail: Phone No `?7Z 2-l(o-8Os-4'7
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 6C-G05`5-5-7IOZ
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:
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 ging twice for
improvements to yoguMoperty. A Notice of Commencement must be record poste on the jobsite
before the firs ecti f you intend to obtain financing, consult with I r or an att rney before
commencin rk o cor 'n our Notice of Commencement.
Sign re of Owner/Lessee/Contractor as Agent for Owner Signature of C r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFe COUNTY OF 3 , l,fJc�Q
The forgoing instrument was acknowledges before me The forgoing instrument was acknowledge before me
this day of '5q t- 2031 by this\\ day of , 20 by
S�c�Jer �a5+av�gJ��1 S��J�.r �e►s�d�t1�.`F
(Name of person acknowledging) (Name of person acknowledging) —T
(Signature of Notary P lic-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of identification , Type of Identifi I .
�l- L L :"��, DEANNA
Produced Produced MARIE GNENS
p�WNAMARIE GIVLte + :*= N#GG 022023
MY cOMMISSION#GG 02'2f,2Cs EXPIRES:Decem�� 20
Commission No. � �' �lplll�S:Decembert6,1<12' Commission N
B Thru Notary Public un%ev*! Notary PuDfi'cbn rwrtem 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014