HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: Z9 - 2015 Permit Number: ��6 `01 1 S
RECEIVED
Building Permit Application SAN 0 2018
Planning and Development Services ST. Lucie COUn y"F'PFIIl�lt1
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
j PROPOSED IMPROVEMENT LOCATION:
Address: 3 160 ill nlfn ## 3C�3 Gcce -
Legal Description: -,l`nrC& �[`k �Y rS l 7_Ll►'+�d�
Property Tax ID#:M'Zf) Lelcl - cot ) -apo- t Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�Cm� naJ b I Ct l r ti'lft-_� rCO—iii C_
e-tee+-ri c �-1 eJctil low . )
CONSTRUCTION INFORMATION:
Add
rtiona wor to e e orme un er this permit-c ec c a apply:
❑HVAC Gas Tank F]Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator E] Roof Roof pitch
Total Sq. Ft of Construction: Z 24 3 S . Ft. of First Floor:
Cost of Construction: $ coCQ Utilities:]Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name n CtCI Name: JOS �l �GCCIY�S
Address: 3 Company��Yl
City: Stater Address: (N(fnr<_brHoe
-
Zip Code: Fax: City: ICS r-c-D StateE -
Phone No.—w3 ' ` 2ucx�� Zip Code: �cle Fax:
Phone No. 2-
E-Mail: `r--1
Fill in fee simple Title Holder on next page( if different E-Mail: wW rirrkp <
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 ne:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: o h e:
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
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 o wner/Lessee/C tractor a—s-Agent for Owner Signatuof Contractor/ l ense Ho er
STATE OY ORIDA 5+- A LOCCOUNTY OF COUNTOFLtDGi C
The f oin instr ment was acknowledged before me
I The f r oing instrument was acknowledged before me g g
this day of no(D 20 j by this day of 20E by
Name of person aking statement Name of pers/OR
aking statement
n
7
Personally KnowOR Produced Identification Personally Known Produced Identification
Type of I ntification Type of Identification
Produ d Produce
I
(S n re of Notary Pub (Signature of Notary Pu - tate of Florida
�►r Notary Public state of Florida Notary ubli State of Florida
Commission No. " ► car�oa���' Commission N� v � W
` My ommiaston GG 163057 , Carob
j Expires 11/2812021 �, Ex commission IIt2ion 21 183057
or h +.,, �' Expires 1 1 12612 0 21
or R
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ---- --- — ---
COMPLETED
Rev. 8/2/17