HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �+ Permit Number:
Millrn �
RECEIVED
Building Permit Application 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 IineSh„*,t,
PROPOSED IMPROVEMENT LOCATION:
Address: 5-1 SPAtNEvmA F�"- (-
Legal Description:
Property Tax ID#: 1301 " 1 ( - it l -' OEaD S Lot No.
Site Plan Name: Block No.
Project Name: bo M4L_b LOLL"
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
t� -L4A Ca 0 E Z oPe,)L Ov S - 4c.eo✓L-bLo - dust_
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check a app
HVAC Gas Tank Gas Piping � Shutters ❑Windows/Doors
1-1 Electric ❑ Plumbing Sprinklers E]Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3350. °-� Utilities: 11 Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ` V t3 ,_-tb W4—LL—r:> Name: TL 61, ,DSc•�
Address: S1 MPXJCMA Company: Alk 44LLrv► LAD,tib ooS 4 boo ILS
City: 1-T. Pi42� State: Address: 4S00 SCJ 51 -
Zip Code: 3441 S I Fax: City: t)-AVLL State: FL
Phone No. CI-11-T10- 8413 Zip Code: 3331`1- Fax:
E-Mail: Phone No. q sq- (Q4S9--1 S`k5
Fill in fee simple Title Holder on next page ( if different E-Mail: Cctr4-k c- .--1Z ,
from the Owner listed above) State or County License: C�-vzC 13 Zlo�i s
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: one Zip: one:
FEE SIMPLE TITLE HOLDER: of 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 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 recorftg your Notice of Commencement.
5 ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO IDA STATE OF FLORI A
COUNTY OF DR-o-JP-2 COUNTY OF C>R-o-.7 + ,"b
The forgoing instrument was acknowledged before me The foWoing instLument was acknowledged before me
this 3;' day of -►A)! �( 20 l t6 by this36 day of JA-VA -H 20 V 8 by
to 04'L_t-6 7-t ry%6TtL-1 iZb3L N So
Name of person making statement Name of person mg statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
0' �7�� QJ4<D �
(Signature , (Sig t e f o u Ii -S too to id )
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CARRIE GERVICKAS TAPP �•Pa P,, CARRIE GERVICKAS TAPPIIcc��
Commissio 1#/. .�- No Public-StkWlllorida Com i hb Nntar�p nn�-crate of Floral I)
'•. .•E Commission# GG 056993 = : :• Commission# GG 056993
9rF o ac My Comm. Expires Apr 15,2021 =9,F cPsc My Comm.Expires Apr 15,2021
OF F
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17