HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I (�L� �,[�
Date: W I Permit Number: J 0U l 5
_ _ _ RECEIVED
Building Permit Application
APR 2 3 2018
Planning and Development Services
ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Y
PERMIT APPLICATION FOR: Demolition a�
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: P� coy-N6,o T fu
L-1L-1S flrD(r,� 51nafC,kv� C�c�rry�wL�� el-e Nn�v1�5 ��. -kS-iu�u
Property Tax ID#; Lk5 o-L oou l'000 " I Lot No. 20414
Site Plan Name: Block No.
Project Name: _
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
00
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit-check a apply:
HVAC 0 Gas Tank Gas Piping _Shutters Windows/Doors
nElectric ElPlumbing Sprinklers Generator a Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ U (i C! Utilities:FSewer Septic Building Height: _
OWNER/LESSEE: CONTRACTOR:
Name �eC-,1/N - �LA,5 (el(l+ - Name: naC'V_ _
Address: `ZD ��� � Company: `-C CWl Y1C - _
City:_aState::E Address: jOqIiQ^1Ce&VI \!
Zip Code:?�-Loi�J�l Fax: 1A-A City: Stater
Phone No. ��Z'ZZ�i-�u3�'1 Zip Code: a LcD Falx:
E-Mail:(V)0 )1L (, WeA-CLA .LOWS. Phone No. '1-12- 22`1-C'1(k,JCA
Fill in fee simple Title Holder on next page( if different E-Mail: 0�
from the Owner listed above) State or County Ucense: -2- l'0O
-CLA .Curet
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 ur Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOI�IQA COUNTY OF '-�A I ,UC�(_ LC:>u� COUNTY OF STATE OF FLORIpA�u`&_ (Oo-V)ln
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledges before me
this 22d"ay^of iry1Gyr, q 20 ISS by this 2-7- day of rVY;�Y`G� 20_ by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
P ced Prod
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( gnats f ary Publ -State ,f a• MY COMMISSION F f ota Public- ate p'.F i a)MY COMMISSION A F 7168
'.rte EXPIRES May 05.
••�•o: EXPIRES May 0 01 y
Commission No.�r Z211 LP _ I) e ! Z 11l1
I L a rwx;tallote seivfr�ommis5�on No. Z1 �;'°�hc•(Seal) f�rktaN 9
as s.vi A on
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17