HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL�E1 INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L Permit Number: -,.Orr(
RECEIVED
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Building Permit Application APR 0 2 2018
Planning and Development Services ST. Lucie County, Permitting
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
PROPOSED IMPROVEMENT LOCATION:
Address: 5 v n S I
Legal Description: i Ut J l QA_ �10 e,r S't a-r�� "0
Property Tax ID#: 2YO oZ -60/?— o t'E9— Coe— L/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
2 OVA-
CONSTRUCTION
CONSTRUCTION INFORMATION:
Additional work to be ertormed under t ispermit-check all appy:
HVAC Gas Tank E]Gas Piping _Shutters F]Windows/Doors
Electric ISPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: r� S Ft.of First Floor:
Cost of Construction:$ -( � Utilities:Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameIra-r-1 Name:
Address: X60 a✓� e- Company: c" 111-0
City: r l -C-V- Stater Address: S w
Zip Code:
Fax: City: � __r Com- State: r
Phone No. — 1 ` 3 S 3 Zip Code: Jn 9 y Fax:
E-Mail: Phone No. I - 7
Fill in fee simple Title Holder on next page(if different E-Mail: W"
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 ' st inspection. If you intend to obtain financing, consult lender or an attorney before
comme,ninif work or record' your Notice of Commencement.
ignature of�LORIDA
ner/ see/Contractor as Agent for Owner Signat a of Contracto /License Holder
STATE OF , / STATE OF FLORI ACOUNTY OF G.yr C COUNTY OF
The forgoing instru ent W s acknowledged before me The forgoing instru ent w s acknowledged before me
this `4.day %
/of f s I 201__bby this D.- day of t' 20_Ld by
Name of pe making statement Name of pers9n making statement
Personally Known V OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
GPG 0
MPN�E°`goo , E�, GPo�e1 ,
(Signature of Notary Public-S florjdL9 ES�J (Signature of Notary Public-State orid �gS�O
:M GO0 REs��ne
Commission No. (Seal) Commission No. ISS}
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
WATER COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728,FT.PIERCE FL 34982
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SEWER RES �•—
NAME
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METER SZ. M/F �j 11.1 o a
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$ ES SECURITY DEP SERVICE ADDRESS �� �l ��f1J� U0
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SERVICE FEE Q U
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SAME DAY FEE SUBDIVISION_ /�� LOT�BLOCK tet'/� N
/ L OVERTIME FEE
c4 L;q — METER INSTALL. BILLING ADDRESS
CFC/WATER
FPUA CFC PHONE# /���-�— b {�, MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
TQTAkL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SSC/ — j ^�
SIGNATURE . FED ID >d'-9Z /y'q�_C//' q
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY,
DATE RECEIVED CASH CHK#� _ RECEIVED BY�