HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED f �,
Date: p Permit Number: 1 g QJ Q "T
- J RECEIVED
Building Permit Application F FEB 14 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
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 �C
PROPOSED IMPROVEMENT LOCATION:
Address: Q Z-1
Legal Description: ( L __N oNi.) unbiv
Property Tax ID# 3 - 2- - - Lot No.
Site Plan Name: ,p ' Block No.
Project Name: _I_ _ U / �QK]`
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
L AIC- S Iste*'I,t I��ce tav-�-. P-��vwv� a 47&V �-fr y 11� coo l
�ier�c. fie + (sew j� f�uN� w`s%nay I�r !lf sy.�r+.r,
Mew 5�S---w1 'is C-oodmew A/N ' AW O"- 5051 M 4 Coved* X l q opt q I ?_-+vN
CONSTRUCTION INFORMATION: VV
Additional work to be gerformed under this permit-check all that appy:
lul
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing U Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ � d 00 Utilities:0 Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name tCk10 15eAName:
_ a
Address: I
' f5 Company:
City: PQ'1 ,L St' Wol e- State: L.-I Address:
Zip Code:3q CK7 Fax: City: C State. n
Phone No.Sllo-Gt2_ 2-2- Zip Code:� U _ Fax: � !�
E-Mail: Phone No. , ' 2'
114
Fill in fee simple Title Holder on next page(if different E-Mail: 1 • l L-
from the Owner listed above) State or County License: (A tJ 16152 17
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 SIMP TITLE LDER: Not Ap licable BONDING COMPANY: Not Applicable
Name: Name:
Add r ss: S 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 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
comm cin w rk or recording our Notice of Commencement.
Signature of OWner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO IDA STATE OF FLO IDA '
COUNTY OF 1;rn QC COUNTY OF V\,rte
The forgoing instr ment was acknowledged before me The forgoing inst rn nt was acknowledged before me
this�day of 20�d by this A4 day of 20J_-R by
v:ck 6�3 L_ rm M% jT)CV ki I 11A �_� aim YN—"S,
Name of person making statement Name of person making statement
Personally Known OR Produced Identification:i.--A< Personally Known OR Produced Identification-Z-
Type of Identification Type of Identificationa�
Produced_A j-67—1 6�—� �;� � ''� Produced 1402—6G
IGs-Q.�) 1 ` y,�•�otrrRY:0��' � ,c xJ�•E,`t�``` ����i���
T71 .j. O�.
It2 ~cpiresi = .•�g f.�pTAgy•.,AL2:
r i
(Signature of Notary Public-StaYg of 11s21.3 r (Signature of Notary Public-State$f Floriolli�TM^�
% O '•Q S orapa0001'321
Commission No.C�U I5Z I �'��'j�•1 4� J.
OF �OP;� Commission No.0 I.S2/ 0;slS �r\p�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17