HomeMy WebLinkAboutBuilding Permit Application ,-ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: °N-1 S Permit Number: /� !�v_ v 14)jj�
RECEIVE®
Building Permit Application APR -5 2018
Planning and Development Services
e
Building and Code Regulation Division Permittin g)Department
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2300 Virginia Avenue,Fort Pierce FL 34982 St.. U C County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: - Q 7o 3 S a S+ti S+. Fo rf P r e re-e F L- 3 $l
Legal Description: r.Xct4 /L 61'r' Vg 2tif lo/1 16 SEER
Property Tax ID#: ooII -.t oo -a Lot No.
Site Plan Name: Block No.
Project Name: >11�_ GG+Gffl�: G`.+
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.OF WORK:
au CIn-Je 704 l6 sr'Ic-R
Model nt, sec- todlmcr; GA14414Oged
a,-r' lc.ndte 1'X`I oNr"0
CONSTRUCTION INFORMATION:
Additional work to a er orme under this permit-check a appy:
9VAC E]Gas Tank E]Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Ar,—(0e, S /1/o e//ce Name: A&m ki-n
Address: 'a"7o 3 s o!K-.rh S-i- Company:
City: PTere-g-, I2L State:�L Address: G o r," it
Zip Code: y 9 1 Fax: City: I/p5f &' =A State:
Phone-No. ISKQ 660-0'73 Zip Code: S3L16( Fax:
E-Mail: crt rlbT+sa49bww,at-r--A Phone No. gaI Gro-0-73
Fill.in fee simple Title Holder on next page(if different E-Mail: r�rriy�I(,z, ,c,c�J aMc.+l•co
from the.Owner listed above) State or County License: ��/_ /fir/5 -25-1
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.
Signature of Owner/Lessee/Contractor as Agent for Owner ature of Contractor/LicerEer5older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF t?0%l IM P.!-e CnC'v\ COUNTY OF f�Q 1(M EtOI CA-1
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 3 day of Q'!7 rL( ,2010 by this '�L day of G`UpYL ( 2016 by
Ca-n R. K,M 1"T rAD411 I4,hn�
Name of person making statement Name of person making statement
Personally Known g OR Produced Identification Personally Known_4 OR Produced Identification
Type of Identification Type of Identification
Produced Produced ��.�` pDA 111 80•
��• �'.• issioN Fy
19�2po
0iiti
1.
• A i� NOTRRy
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(Signature of Notary Public-State of Florio) r Gooytp.oH'' -5,- (Signature of Notary Public-State of Floridal PVgL1CNO 00e
� N' f
Commission No. 5Sealf �;=Y�o'Z €ommission No. (Se�1� ;0232150 \�
�t*�CLIC •, u� o
�N• O.
REVIEWS FRONT ZONING �6�F..••.�/%so PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW R� W REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17