HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5111 �� Permit Number:A05 J0d5i
l.P..75
�� N M RECEIVED
MAY 0 12018
Building Permit Applic tion
ST. Lucie County, Permitting
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 !�
P ERMIT APPLICATION FOR: _ V�
PR F4FR9ftVENT Ld / /
Address: FI 584 13 I D �v C1' fp L 0 ��• AX e
Legal Description: f}04011? H CLu9-PL NT DNS - 8W 1 L07"�? (OK V0P7-
7777 `fo8'7 - /oF/
Property Tax ID#: 3L&257- 10/ - 0 0 3 9 - 000 — Q" Lot No. al� _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
liellg o I It! ACP (A-CA- 01 A.A Ac
P-0-P (71AWK0 I IlElet f7q6r Aec., r4x- ruAL
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator _P-Roof Pitch
Total Sq. Ft of Construction: 0? 0 Sq. Ft. of First Floor:
Cost of Construction: $ !7 D Utilities: —Sewer _Septic Building Height:
Name A10A V
cS Name: n AmJ9
Address: //g(�Q 9lo��y C�. Company: fIQC.� 1�.-i-t� `F, na LLC
City:Port t S1. State:/C� Address: %"f 9 Std, WaG -e :e 1 d S�--
Zip Code: 3-f-( 7 sa' Fax: City: Port+ 54% LuLl-ez- State: I<`�
Phone No. V zlotp - A S-0 G Zip Code: 3 qa S va- Fax:
E-Mail: 1'1'1 E X S W Q Q13M; Phone No (77ZO-,�/,�- 5-1 S Lf
Fill in fee simple Title Holder on ne page ( if different E-Mail R 0 tAtil Ll 0 Ge m
from the Owner listed above) State or County Licen e CCC 13 Q '6
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 ith lender or an attorney before
commencin ork or recording our Notice of Commencemen
Signature of O ner/Less /Co tractor as Agent for Owner Signature of ntrac ce a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The folding instrume as acknowledged efore me The forq�ing instrume as acknowledged fore me
this/ day of 20 by this�day of /� 20�y
(Name of person acknowledging) (Name of person acknowledging)
' r
94-1
(Si ture of Notary Public-State of Florida ) (Signa ure of NotaryPub ic-State of Florida )
Personally Known � OR Produced Identification Personally Known 01.13 Produced Identification
Type of Identification Type of Identification ?"
Produced "ary Pub4C State of Fonda Produced ;' .;s 'Jntary punk state of Flonda
Bramdon Smith arn�th
My Commisswn GG 137433 -�r-soon GG 137433
Commission No. Torg R"pfeJ9@'3�21 Commission No. :uI021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014