HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 to 60l - 064 L
RECEIVED
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Building Permit Application FEB. 0 6 1018
Planning and Development Services Permitting Departmen�
Building and Code Regulation Division St. Lucle 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
PROPOSED IMPROVEMENT LOCATION ;..{
Address: 1�4 hjiV ta,n a e 00004 ' 2ma-61 e Al7 K 9
Legal Description: &&r b ou r' 2 gLA z3're 4/06.4 V; II&O'e U H 1'�E S
Property Tax ID#: Y Y2(a-- k0 Y- 9 01 S - 1000- (9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETP►1LEp.,DESCRIPTION OF 1IVO:RK
p la:c,,n� 19x7 C-wa9e Door W/ 19X 7 Argotrr M iA". 6ge/r•
0100f. L; v e
CONSTRUCTION INFORMATION
: .
Additional work toe e orme under this permit-check a appy:
[]HVAC 13 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
U Electric ❑Plumbing ❑Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:0Sewer 0Septic Building Height:
OWNER/LESSEE :` 'CONTRACT .
Name JoLn Name: e.,; Looe7-
Address: /31 &1 Al W Lab cif&jn ad ,r�r. Company: W t 1-_4 e i rY0 &IngA� -�yC>✓s
City: Gl o� r'-�y State: FL Address: I g17 -s w / ;(�,Ic;r. '4yP11
.
Zip Code: .3 Y29 0 Fax: — City: PON-,' 3;L. LLL,e i if State:—a
Phone No. (7 7,9)1 3 A,- y(o y� Zip Code: 3 Y9�3 Fax:
E-Mail: — Phone No.(770') 370- 914 (,2
Fill in fee simple Title Holder on next page(if different E-Mail: 9 C4,2/ /W—L12 y ASL,do _ cd w,
from the Owner listed above) State or County License: � I-e13
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 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 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 workey recording our Notice of Commencement.
_ r
Si ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO STATE OF FLORIDA
COUNTY OF - COUNTY OF
The forgoing instruff nt was acknowledged efores The forgoing instrume was acknowledgedbefore m
this�day of 20Jby "' this 16i day of 201 by - Q. OF
A
x�i
6
Name of personinaking statement ' Name of person making statement ai:R,&
o
Personally Known OR Produced Identificatio CA in Personal[ own OR Produced Identifica io a m_70
Type of IdmT is tion a Type of I enti on
'Produced ��{y=�7 Produced - sg
(Signature fNotary Public-State of Florid .
(Signature of N ary lic-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17