HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l —/O Permit Number: f�y� • (`�aZ�
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Building Permit App icationPR - 2 2018
Planning and Development Services Perrrllttln De artment
Building and Code Regulation Division g p
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie C ty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR:
PRQPUSED INPI�OVEMENT LQCATIC}N
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Address: /072 6- dee4n Or. 7 9 ,f oto i /geaa4 GL. 3"677
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Legal Description: Aah ul 4f Zile,e
Property Tax ID#: e/�J/1- 50J- 01,2 577 - 0007 Lot No. W 12.
Site Plan Name: 17/lJ�dca�i ��i/ Block No.
Project Name: 75?
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIPTION FW
COM fe ®/l7es`on n rPi�o�u S—X7 le �iojn
CONSTRUCTION.INFO RMATION
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itiona work to be pertormed under t is permit-check all that applyl.
_Mechanical _Gas Tank- Gas Piping Shutters —Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of..Construction: 677 Sq. Ft.of First Floor:,---
Cost
loor::Cost of Construction:$ 1900.Qs Utilities: Sewer _Septic Building Height:
OWER/LESS.EE ' :; CC'}NTRACTOR: s
Nameh0r_q ue �d-�DcS�u�{f Name:
Address:_10 72 S S OceaA 9r. Company: '44-7 J�;i fq �Odua�"Svr: i✓�c•
City: )eOjzn 8eucA State:IGL. Address: Sr.
Zip Code: 319.6_7 Fax: ' City: , ',Iom R6 ieg State: Az
Phone No. G7' Zip Code: 5-7 Fax:77.Z,2.3.2l.2/ql
E-Mail: ro12 A.* s*.S 0 .p e f Phone No 77.2 -,7-4y `-771f-
Fill in fee simple Title Holder on next page(if different E-Mail RY940. eem
from the Owner listed above) State or County License CQC 12,f-19191
If value of construction is 2500 or more,6 RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW fNRMATION:
DESIGNER/ENGINEER: Not Applicable- _ .- pp MORTGAGE COMPANY: �pLot Applicable
Name.
Name:
Address:_ ` : ` Address:
City': State: City: State:
Zip: Phone Phone:
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FEE SIMPLE TITLE HOLDER: Not A Iia le LADING 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,
accessorystructures,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 woJ oXecordingXetipNotice of Commencement.
Signa ure of Owner/Less a Contractor as.Ag t :' ` y er. Signature of Contractor/License Holder =aoq, �
T �: ��; ;„
STATE OF FLOm; STATE OF FLORID
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COUNTY OF • COUNTY OF X�a
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The forgoing instr nt was acknowledged be E�""9 The forgoing ins ment wv s acknowl 'I'!.
dge befo
this day of 20 b k N§Q this day 20by = z
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(Name of person acknowledging (Name of person acknowledging)
(Signature oft ry Public- a e of Flor a) (Signature of No Public-State of Florida)
Personally Known � OR Produced Identification Personally Known /OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014