HomeMy WebLinkAboutBuilding Permit Application Jan. 12. 2018 1 :24PM No. 8161 P. 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date- a Permit Number: '- Oa 5
t RECEIVED
_ •_.:_._._�_
Building Permit Applicati n JAN 12 2018
Planning and Development Services p�Ptplltting
ST.
Building and Code Regulation Division Lucie County,
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
PAbPOSED I1V p " V MEINTr`,I�QGiq"fl
Address k0 �- 3 4 9
Legal Description: — 1
Property Tax ID##: \3 O " ��1 O3`{ 0 - BOO —s Lot No. �
Site Plan Name: Block No. $4
Project Name:
Setbacks Front Back: Right Side: Left Side:
C� TA14 D DES AIPTIQ of-NSK; 17
R-
Q 4 r 1-,e, der- w 1 e xpc�r\5_ib�n,7CX,,k
CQ:NSTRI�CT)QN JIyFflllIATIQN . {(/
Additionaf work to be
per orme under t rs permit—check all appy;
❑HVAC LJ Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
FElectric ®Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �$.9g Utilities:11 Septic Building Height:
777
„GOIUTR f�TDp �';'� ��; p,,,,{,� �
.. . . :. _. _... .. .. _
Name Name: �o�ry 1i.) `C.yeCS
Address,(_i101 \►foods erg VJau Company:1,,a
City; 1:0T+ ,erCe State:-IF Address"14N) \J � �V o1.,y. 1
Zip Code: 3 4Q5) Fax: City: QCQ no a (..;'�r W State:
PhoneZipCocle: _�`�(e3 Fax:3Q).Q0 .3919
E-Mail: Phone No. 3 - a,,� :3 3939
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.
Jan, 12. 2018 1 : 24PM No. 8161 P. 2
5UPPLC Mf NTAk,C0NSTRU,CTI ORLI (AW JN':rQkMATItTN,
DESIGNER/FNGINEER: _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 Horne 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 work or recording our Notice of Commencement.
Signature of Owner/Le ee/Contractor lint for Owner Signature of Contractor L ense Holder
STATE OF FLORIDA 11 STATE OF FLORIDA ll
COUNTY Of COUNTY OF 13 ccU OL c`d
The forgoing Instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this Q_day of ,201 V by this_„ day of -- 20_L by
c�C VJ v rs c f S
Name o erson aking statement Isla—me of p son,making statement
Personally Known I/OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produce
JUL Q,
(Signature of Nota 4 Dina T IAPETE (Signature of Nota Public t
+ , AffCO �ONMt3ti010297 Commission No. Du►rFT.�[[��
Commission No. GOMUIS5R3N��a01028J
IREB:Juh 91,Y020
Bonded Tr"N*ry MR underwrilln ?. F1tP1AE5;luh 3t,X020
WiledTtuu Notarypub8eundrtrwrllMs
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17