HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \e,. Permit Number: ytoj3-(3�o
RECEIVED
Building Permit Application MAR 16 2018
Planning and Development Services
ST. Lucre County, PermlEf(P19
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�� L
PROPOSED IMPROVEMENT LOCATION:
Address: '\ spU t)C,
Legal Description: 91 V(-2 ?&RY, - ld ► T' S Plotz y — ?)W\ 1__4 op
Property Tax ID#: 3y \- Sro 5 a�y� Lot No. q
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONO F WORK:
`' 5 C e-/Z- l ul'ic1t�C
L /c� Ce._ lik eol&"ix- Du
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all apply:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 11.-74 5 . Ft.of First Floor:
`
Cost of Construction:$ X0 Utilities:RSewer OSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name j JAla I��c.�SS _L.nvr ,rr�Ftii-S - Name:46wL Ad dik
Address: Z46 A)6 J-tapil;0 f-i,Gt Company:
City: State: fq Address: ,Jt1.J u
Zip Code: 4-Fi 23 Fax: City: L Stater
Phone No. �l L -.? t S'— 4l Zip Code: 3*C?.SZ6 Fax:
E-Mail: Phone No. d-I -70Cd
Fill in fee simple Title Holder on next page(if different E-Mail: J�4E (0 4,4oVE Aff A( .1-9
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: 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 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.
Si atur Lessee/Contractor as Agent for Owner igrla ur rac or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF tl� , COUNTY OF Luc
The for oing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of 0� ( 20 IN by this ��o day of`f h4 ( 20 by
�C� qyh--e" S v"S
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L Produced L 1Q L
u
(Signature of Notary Public-State of Florida (Signature gnature of Nota ry + blic�St
1;
p=/1NNARIE GIVENS
Commission No. >R1kC!'� Commission No - j 1Y:0M'!IIs G0�2�'v7
o;- �a 0uu 2020
COM"•dISS17N# 6 `4, I*_' ?": F�CP1nE5: )erember 16,
r MY RmbQr 1 +L9 O= Nota F::blic Jrderwnio s
~= EXPIRE5: ��,der: %red,.�o ' Bonded 7hru N -----a.
3r: ot2ry p'rt,11 �.�
REVIEWS FR G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17