HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO Mrs-UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /,� 1/Q Permit Number: \� '-
RECEIVED
• JAN 16 2018
Building Permit Applicat 9P
Lucle County, P6rrnittltl
Planning and Development Services
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: 105, *J oy%-% t Ap+-% FL, 34 C1 5
Legal Description:_,pgc 4\_ r±lLjb Coxch t!n Gv,&__
43
Property Tax ID#: L4s 1_I SoD O d 34 ocg%3 Lot No. i "a-
Site Plan Name: ,_ -e e- Block No.
Project Name: ) tv/
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
U,.Y'4010(,,4J 0"6 CSW Q-P --
IV , PCC-+ W► _4vj5
Mark )od �
CONSTRUCTION INFORMATION:
Additional work to be oertormed under t ispermit-check all appy:
HVAC Gas Tank E]Gas PipingMGenerator
Shutters 56-Windows/Doors
11 ❑ Plumbing Sprinklers F] Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
00
Cost of Construction: $ �dOO ' MS `S Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name L 4.2,11a, Name: )�* 4tt- 4*',c
Address: 40 S ,p, 14 ' Lir/a,- /9/'. Company: •M "�7k•�►
City: " i_ State: Address: (DiNg a J 14+ k A,L talo
Zip C6/de: 3 y9S 7 Fax: City: Fk. low State: Pt
Phone No. / 5 4f - �� —�a Zip Code: Fax: x
E-Mail: P r��. �t �/� 2m� /O/rt Phone No.Aq4 _540 3(a g 1—
Fill in fee simple Title Holder on next page ( if different E-Mail: t,-,-r-NAC, ( rfnatvh.c
from the Owner listed above) State or County License:C_G(__0 Ip�
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 your paying twice for
improvements to o r property. A Notice of Commencement must b recorded nd posted on the jobsite
before the fir Ins ection. If you intend to obtain financing, consult it len r or an attorney before
commen ' wor or recording our Notice of Commencement.
aluc'
Signature f Owneressee/Contractor as Agent for Owner Signature of Cor41 z nse Holder
STATE F FLORA STATE OY OF OR A
COUNT F rDc�cr
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this J_Q_day of JO,nt-4-N 20_]J7 by this 1Q day of 06-'AJ 20_qrty
Name of person making statement Name of person making tement
Personally Known�OR Produced Identification Personally Known_ OR Pro uced Identification
Type of Identificatidn Type of Identification
Produced Produced
(Signa e oi4otary Public-State f Ftpr"rGi..,) JAMIE DUF Ignat re Notary Public-State of Florida )
":; N
MY COMMISSION# F 86725 V0 "'
Commission No. ,� ) Clommis ion No.F� I + (SeagAMIE DUFFE
„�►a,w„ff EXPIRES Januar� 1, 2019 }
MY COMMISSION#FF16 5
(407)39"153 FloritlallolaryServi e.com � EXPIRES January 1, C 19
a otaryService.c m
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17