HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ® V'
RECEIVE
Building Permit Applicatio APR -5 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Reselie County, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT-LOCATION.
Address: 10490
Legal Description: CLC3.5 d
Property Tax ID#:'v2#04. Lot No.
Site Plan Name: T Block No.
Project Name: /'1&U1_,&*
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
J AAA4 4444J.
CONSTRUCTION INFORMATION:
Additional work toe nertormed un er this permit—check a appy:
HVAC Gas Tank Gas PipingMGenerator
Shutters Q Windows/Doors
0 Electric ElPlumbingSprinklers Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ It � - 9 L9 - Utilities:CnSewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Names Yx y GName:
Address: R. 0 / 9 Company:
City: State:W& Address: 3 '
Zip Code: J 8-2?1 Fax: City: .t.?.{� State.
Phone No. Zip Code: 3W.YS Fax:-��/- 77 8
E-Mail: Phone No. 4/10/. -17 7 '7
Fill in fee simple Title Holder on next page(if different E-Mail:Mi Ike V pard e • e 1AP-4k i Col. C a+'k
from the Owner listed above) State or County License: E0_ J.3406-..Tc?5!9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'SUPPLEMENTArCON- CTION LIEN LAW,INF:ORMATI;ON =-
DESIGNER/ENGINEER: ._ Not Applicable MORTGAGE COMPANY. Iot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
oe
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: blot 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 nosted on the jobsite
before the first inspectio . f you intend to obtain financing, consult with lender or n ttorney before
commencing work or rep(brping your Notice of Commencement.
A/Jdu,�'PJ
Signa r f Owner/L ssee/Contractor as Agent for Owner Signa re of Contractor/ 'cense Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF :s-r Lr u G I 6� COUNTY OF Gt C 1
The forgoing instruent was acknowledged before me The forgoing instrurApent was acknowledged before me
this 4,
day of L 20J 8'by this b day of W4
day Pit)
rL_ 20-9'by
,,
Name of person making statement Name of person making statement
Personally Known ✓ OR Produced Identification PersonaJJy JCnovy ✓ OR Produced Identification
Type of Identification Type of Identification
Pr-od4ced Produced
I Jc'/� i J/1�� (D
(Signature of Notary Publi -State of Florida) (Signature of Notary Public-State of Florida)
1DAVID RA OND PRUE
Commission No. �t- �af� r NOTARY PL BV&nmission No. M V-6 7Y- &STATEOF
DAVID RA PRUE
STATE OF LORIDA NOTARY PU L
a Lamm#FF1 2675 IDA
to Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTL MA MP 19
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17