HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a - 9 - I E Permit Number:
Building Permit Application
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
Address: 1-3(0 RQ(YJf_')a I Ont,
Legal Description: 'To \ M C) Lc y e- si DIN K J I ci 3
...1410
Property Tax lD#: I - scil-t3 -- oaI - Ca) - 2= Lot No.
Site Plan Name: Im Block No.
Project Name:. in
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
e'" ICY'li e- C-cf-6 Y e-q'V aC 12- ) 51-1 V\J i 11Cll 0\A;
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CONSTRUCTION INFORMATION:
Additional work to be Dertormed under thispermit -check all that apply:
OHVAC Gas Tank [_] Gas Piping Shutters Windows Doors
F]Electric Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 12) Utilities: SewerSepticBuilding Height-,
OWNER/LESSEE:
CONTRACTOR:
NameLewi1h
. ,'�si L,,jn(i,I:QI mi1
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Name:1no'�(3 i_f)2i
Address: ( AfujQ Loole-
Company: lbe
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Address: 3X0_1(_LSEbjxte
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City: State: FL
Zip Code: ,�ACt �,�, Fax: N)
city: (D i`-$
— I State:
Phone No. '"Ti.
Zip Code: ?�AClq_l
Fax: "i
E -Mail:
Phone No.�
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E -Mail: rPtM
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Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
State orCountyLicense:
"J
IT vaiue OT construction Is:>Z5UU or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 Counter 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 attornev before
comme_agng work or recording your Notice of Commenceme
Signaibre of Owner/ LesWe/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ;f
COUNTY OF CA,n COUNTY OF A y -ii n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Cf day of 20� by this Ck day of d 20 by
I
Name of person gidking statement
Personally Known OR Produced Identification
Type of Identification
Produced
Name of person mpkfhg statement
Personally Known OR Produced Identification
Type of Identification
Produced
Rev. 8/2/17
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(Signature of '�iotar
(Signature of Noy
Commission No
o�n,,, y KEL�Y WIDMAN
•`tPA PbBis, State of Florida
-a. „o: Notary
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`<a�r °Oen;-,
Commission No. ;_ *
KELLY IDMAN
Notary Public{Sjtyj of Florida
- Commission # FF 929255
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Commissio}ji # 929255
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REVIEWS
FRONT ZONING SUPERVISOR
PLANS VEGETATION
SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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Custom Mirrors - Shower Doors - Table Tops
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3570 S.E. Dixie Highway ® Stuart, FL 34997 ® (772) 286-0459 ® glassprofessionats@omail.com