HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ry
Date: Permit Number: U(
RECEIVED
APR 2 6 2018 1
Building Permit ApplicatiJ!ST. Lucie County, P__rmitting J
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: -DooR /a&e)LE ENDS
PROPOSED INP^R�OVEMENT LOCATION: G
Address: 0403 Clnvm LoA,.Z.. Ft. Pj R . Z✓4 {5
Legal Description: �'C.. � `�N�< 1< K14 9 �• 13 �1 30
Property Tax ID #: I.JO� - (CO$- 01501- 000-Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
3 & v` w•e, �l
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _ Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
4� (� 0
Cost of Construction: $ Ngo"`•' Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Jub'%TH Al• , V'r-wallA Name:hh zii++l�__1'�1,,
Address: 3 hR_ Company: C EKMIL F, CORP.
City: T 1,I..• RQNU State: Address: 31loO TVg—iL.E Dove
Zip Code: 544)5t Fax: p City: W P P3 State:F
Phone No. �7,�- ,z�.Zv 0(�,� Zip Code: 33 11 Fax:
E-Mail: Phone No 5 520 0541
^$
Fill in fee simple Title Holder on next page ( if different E-Mail G ComCGV� • hG
from the Owner listed above) State or County Lice n Ux(i
O
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORmOlON: 17171
�
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.
olffm ==% amn
Signature of Owner/Lessee/Con actor a Agen or Owner Signature of Contra for/Li nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument as acknowledged before me.,,--
this-16
e.,,this L day of ISP✓-1 20� by this 10 day of d er-i 20 ik by 0e
_L mep•
d CO H to J"
u(1 C-.(1 Cil Ca f�'�c� Cr X C4
m W O ���C./� I l ,�T� n�0 W N
(Name of person acknowledging) u 0 o" (Name of person acknowledging) v?"'.yN
tp it HN Q.0 Cc 0.Du_ y >I
o �% / l/' //�`� ! Q E tai
(Signature of Notary Public-State of Florida ) v„ > (Signature of Notary Public-State of Florida ) V 4 t>
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Personally Known 0 OR Produced Identifica n `o-lo, Personally Known // _OR Produced Identificat
Type of Identification - _ Type of Identification =_� '_
Produced Produced
Commission No. 783B,5y (Seal) Commission No. G&I 7,'3155 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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