HomeMy WebLinkAboutBuilding Permit Application All APPLICABLLE/INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: �f'' �' Permit Number: r �'
will
---- RECEIVED
U410-OUAW- 0-10APR 19 2018
Building Permit Applica ion -
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: r0-4 �� �,� LLi �� e r)C
PROPOSED IN ROVEMENT LQCAT1tIN: 4
Address: r ,- /r S L %L •
Legal Description:
Property Tax ID#: 7 �1 ✓ ��y Q �� -�ro Lot No.
Site Plan Name: Block No.
Project Name: ,PICK CA cShc �'taCOnu-� �v�.a1V�
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRIPTION OF W®R+K:
L Y�J LL.v 5 L !3,0e-VC ✓ ('�-D i-r iT14 ✓'�..�11A 6!:j L,4J c
0 t �l ea>^ V
Si, n le
Ut0
C
&N'SOT INFORMATION:
Additional wor to be peffo—rmed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
EI ctric _Plumbing Sprinklers _Generator Roof . Pitch
� g —
Total Sq.Ft of Construction: 2`�� Sq. Ft. of First Floor:
Cost of Construction:$ 12e Utilities: —Sewer —Septic Building Height:
OWNER/LE-S-SEE:
' ,r Name. %3`%� 'l� L � /^`i1 LL�1� -Name
` Ad(iress Company
State: _ Addres c
��'
Zip Code: S Ll�S 2-lax: City: Sl
State:
Phone No. Phone No-2 '7 2 -3 Z I Zi
� _ 7 p Code: Fax:
E-Mail: f��a� /`� 1/kr
!�' `+��f�j'D�• a+
Fill in fee simple Title Holder on next page(if different E-Mai
from the Owner listed above) State or County Licens
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
SU' PLE�IUIENI"AL CONSTR�U'CT.®N LIIEN LAIN I'N�FORMATIQ►N:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:` Name:
'Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: ✓ 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 Own e4-466_e/Contractor as Agent for Owner re of Coc o icense Holder
Ry
STATE OF FLORIDA STATE OF FLORID
COUNTY OF SQL Luc), (2_11 COUNTY OF `' VU�P�
The str nt w s acknowledg before me The oto ins ent was acknowledg efore me
this day of. 20 by this day o 20by
(Name of person acknowledgin (Name of person acknowledging)
aclo,
(Signature of tary u lic ate of Florida) (Si ure ofary P - to of Floridt)
Personally Known OR Produced Identification Personally Known O Produced Identification
Type of Identification dentification
Produced DAVID ALAN JO NSM d `,ti'jyp��i�� DAVID ALAN JOH N
°o' ;State of Florida-Notar blit
-`1 ��;State of Florida-Not ry Public :; .: Commission # GG 1 2 48
=• •= Commission #GG 1 2248
Commission No. e,�l) i ion No. V,2 e y Commission Ex i s
aM Commission x R@ -.,� aF; y
'�� ����+�`� y January 03, 2 22 Januar 03, 20 2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014
_ I