HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r/
Date: -� V Permit Number:
V����� 4� �. � RECEIVED� �
.......................... ................................
1111111111111111110 Building Permit Applica tion APR - 9 2018
Planning and Development Services
Building and Code Regulation Division Perm Ittln epartment
2300 Virginia Avenue,Fort Pierce FL 34982 UC� COU nty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re
PERMIT APPLICATION FOR: A e4 ,0 0A
PRC3POSED 1NPROV MENT LQCATIC}N
II .
Address: /.39 ll&#Ief 91y / Je,?fl,l Yea 4A I--L• 3Y9:� 7
Legal Description: 1e&JCJ J5,, C5YY-28/7,
Property Tax ID#: V5_02 02 - FO/ - QJZ 5-- 000 - 5 Lot No. l
Site Plan Name: Ae{f lel Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAII.Ep DESCRIPTION:C}I*,WORK
e
,v e.l e eiwo ,Aioil ai /'emava� �fti G30 617C /nod;le Lioh,e
/oma. a rOoM
CONSTRUCTION INFORMATION ;' fr '`
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: D Sq. Ft.of First Floor: O �®
Cost of Construction:$ moo, Utilities: XSewer —Septic Building Height:
WNERf LESS E CONTRACTOR _
_. ,. .
Name D29 n Pt'A,7&-#e. /v "a wJ Name: c)M i
Address: /_? AXIS 7y/,-.S Company: . , ,f i tX g0Jf,?1 Svc. -tee .
City: •)P,4_5-e,7 9660`, State:A-L• Address: 4K/ _, 2812cel . V
Zip Code: 311-?,5-7 Fax: City: fPhSL'n 1&-yei State: /cL•
Phone No. 77,2-2.2 g-,2 y6 7 Zip Code: 3y95 7 Fax: 7V-,232-.2-191
E-Mail: Phone No -260 - 3775—
Fill in fee simple Title Holder on next page(if different E-Mail CtG�a m S��fh irlC @ Q 4219- e,,9127
from the Owner listed above) State or County License CBC 12 5__/7,F1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCI"1ON LIEN, AW l,NFORMATIQN,
DESIGNER/ENGINEER: ��� , , _
Not Applicable MORTGAGE COMPANY: Not Applicable
Name: ... .. Name:---
Address:
ame:._Address:
City State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
- 'Address: Address:
-city: . ;.J 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 thepermit 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.
N � N
Signature of Owner/Lessee/Contractor as Age n fare Signature of Contractor/License Holder �N
�LL� CL
STATE OF FLORID STATE OF FLORID Z
COUNTY OF m A COUNTY OF m
2Li�¢ z
The for oing instrum t was acknowledge of � The forgoing ins ent was acknowledged b 3 e
this day of 20 �Yby m this day o 20 / �W
— m
(Name of person acknowledging (Name of person acknowledgingAux,-7(N , 4L') IldniAll'
)
LTJ,
(Signature of N t ry Publi
/c-State of Florida (Signature of tary Public-State of Flori a )
Personally Known l 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 SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014