HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: / Permit Number: ` .
• RECEIVED
Building Permit Application
Planning and Development Services
MAR 3 0 2018
Building and Code Regulation Division ST. Lucie Coun Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentia
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: r
Address: '/ ;7 `/`� �o f �2 >(1 t' �'� . 'P e_ C Ctz L
Legal Description: O- X'}-f_- jQ 65 5& `>'C� �1/ (o�•�� rf e r �07�
7 G k �� o Ili • 2?) 7�r% 61C �z)
Property Tax ID#: 3 y0 r�� - y�' Z(� ' Lot No. +�L
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
_reul Ou4 arid( of- old K 76krcJ� &z;Gr O-Ac,( v�clf�.((
i6X7' Ove&v3 P_,..Ad1YXC3 Prvc���+ cj�•r�•o�zclvc�c ,
CONSTRUCTION INFORMATION: J
Additional work to be nerformed under t is permit-check all appy:
HVAC Gas Tank Gas Piping _Shutters u' Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ i Utilities:Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name _3o t 5 v Name: Gr /h-e e- , y j
Address: cT C2 >7 Company: _RG Cc�rc-_q Deo r R c+S Uc_
City: ( Q f-ce- State:_kL_Z- Address: a 7/ -5u-) c..Jc, /. v�Q.
Zip Code: I L-1 q ?_I Fax: N City: Pac--i- S 1. Lv c. e State:(L
Phone No. 7 72 L(O ?�(� 115Zip Code: Fax: A)
E-Mail: V/A Phone No._ 172- o2(21 J' 3 6 S
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License: -3 )3 /C(
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 Appy le
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: �J Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
O ER/ 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
commencin our Notice of Commencement.
Signature of Owner/ ssee/Contractor as Agent for Owner Signature of C tractor/License Holder
STATE OF FLOSTATE OF FLPRI A
COUNTY OF y-�� • ��C �� COUNTY OF
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledge efore me
this day of� -YG� 20jy by
C—'� . TZ
Name oj<}�ec�orymaking statement Name son making statement
Personally Known OR Produced Identification Personally Kno OR Produced Identification
Type of Identification Type of Identification
P oduced _ uce
,, MORAIMA RAMOS � MORAIMA RAMOS
r°` "�� MY COMMISSION#GG15673 MY COMMISSION#GG156738
EXPIRES,OCT 31,2021 EXPIRES:OCT 31,2021
insurance
(Sign ture of Notary Pub - Sig ture of Notary P lic- t
�P I
Commissi No. U (Seal) Commis ' No&. ^l�� (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17