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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f , p' Permit Number:KECE
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Building Permit Appliction APR 1 8 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. LUC - U nty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R
PERMIT APPLICATION FOR:
PROPOSED {NPROUEPUI`EN1` LOCATI`ap'N: 10 MEN iiiiiiiiii;I
Address: Z v �f !/'(S�A T Vl.�r� ���✓`�h�+c�a� ( /®L
Legal Description: -e C7 G-A 11(3 I✓/ dYWC_
Property Tax ID#: - s0- � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET II_ED DE-�SCRI�PTION OF `OR4K:
CONSTRUCTfON INF©RM TION:
Additional wor to a per ormed under this permit-c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric45 lumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Constructions: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: -Sewer —Septic Building Height:
OV!/NER/LESSEE: CONTRACT®R;
Name DP)V�lib h io Name: o V^^-
Address: 2`1 �A��ti U Company: /4,A i,^ Ig l(J 1' C
City:_G V4- o c-V`�" State:e� Address: / 7 7-J- Sf--' c l.,,
Zip Code: '�Y5-5-Z- Fax: City: Stater
Phone No. 2f Y 1 0 C I I-y Zip Code: Fax:
E-Mail: Phone No ��� <J�
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SE�IPLEMENTAL CaNSTRUCTE®N LEEN LAW INFORMATEQN:
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 oft is requested permit, I do hereby agree that I will, in all respects,perform the work
in accordance with the app ved ans,the F , ida Building Codes and St. Lucie County Amendments
The following building p mit plic on re exempt from undergoing a full concurrency revie oom a itions,
accessory structures,s in g p s, nces,walls,signs,screen rooms and accessory uses t nother on-residential use
WARNING TO O N . Y f ure to Record a Notice of Commencement ma r suit' yo ing twice for
improvements y p y. A Notice of Commencement must be rec ed d os d on the jobsite
before the firs ns ct' ou intend to • ncing, consult wit nd o n torney before
commencingor or o -ice f Co encement.
rz� .
N
Signatur of Own /Lessee/Contractor as Agent f 6v-ar� SignaturVFFLOR
o act r/License Holder a LL
m
w�c�u�
STATE OF FLORID ooa STAT ID Y
COUNTY OF ¢rUj:1 COUNTY OF a
The f r ping inst.TAipent was acknowledged before a:*'.'agao, The f , ing instr nt wa§.acknowledge �fo rr�
this day of �I 20 y Py" this/ day of 20�(� by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of N ary Public-State of F orid ) (Signature of No Public-State of Florida)
Personally KnownOR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Iden ti n
Produced 'C-1 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
Rev.