HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //��
Date: Permit Number: V
1 I�1
RECEIVED
Building Permit Application APR 18 2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 V/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 1)4 S k.r-1 Ave , P�=!+ k__I-4 LLA CG C '(_ L-1 ( ?S 7
Legal Description: t �yfr el, 4- 61K 'IU
PropertyTax ID#: Lot No.��
Site Plan Name: Block No. rILP
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
(Ltm,Ve -eViS-hnS roof s!AS.4crn C4Z,wn tz, In54c 11 3O I h.
1-iry- : InSM 11 3S r69 5WS-kvn
Additional work to-be-p-erl'brmed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _ oof
Total Sq. Ft of Construction: ��M Sq. Ft.of First Floor:
Cost of Construction:$ < </L C) Utilities: —Sewer _Septic Building Height:5P_2�_
..01111{tE _ E CONTR 3>,
Name Name: -------
Address /Q,} Juni S Z n Av'e Company:` t- LL6c
City: 000 St- LLAQ z Stater Address: Q&d'0 Gadd .
Zip Code:-3 c(���✓ Fax: City: i�bf i S f L N 6-c State:
Phone No. ju I "�'� e '� I Zip Code: ,�`�G1 n Fax:
E-Mail: Phone No f --- 5`'(q n)61
Fill in fee simple Title Holder on next page(if different E-Mail ,S+L u C� C.r',),) •-1ckh�:j-D • ° yn
from the Owner listed above) State or County License.c C%c
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
U.P MENTAL CONSTI1 MON LIEN CAW fN OR11lI Tf N:
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.
Signatur r/Lessee/Agent Signature Con actor/License Holder
STATE OF FLORIDA , STATE OF FLORIDA (�
COUNTY C. COUNTY OF J The forgoing forgoing instrument was acknowledged efore me The forgoing instrument w s icknowledgecj pefore me
this _day of O Qom, I ,201 by this La day of 20 by
i t' C-G-P L. M , � ef-(um &mz -n
(Name of person ac owledging) (Name of persona owledging)
(Signature of Notary Public-State of FloridIi (Signature of Notary Public-State of Florida)
:�`'' - CO A E PROULX
Personally Known L =�� 9 c Personal) Known �OR Produced Identification
Type of Identification -� � X0 8���00 Type of Identific '
EXPIRES September 18,2018 ;:�"' CONSTANCE pROULX
Produced produced
i 8NO1 .=n MY COMMISSION#FF 180517
Commission No. (Seal) Commission No. EXPIRES Septe4l$M",2018
(407 98-0153 Ftp„ 8Npt8gS8rVi_W-00M
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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