HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
RECEIVED
MW '
Building Permit Application MAY 0 4 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRfi) €[' IDVEMENT rifle : ,
Address: "1v l �i�I _ p6
Legal Description: 3(13( - 1703 _- QJ ,V 660 -q
L,Ak'C L(-,(-Te ESTAig; "i- NU. cy)c L,or111D �og 9V9,�-ai)
Property Tax ID#: 3VLX_ '763-- -' / Lot No.
Site Plan Name: Block No. 0/,L--
Project Name:
Setbacks Front Back: Right Side: Left Side:
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es
CONSTR.UirTIoN'iNFbRMATiON_
Additional work to be ertormed under this permit—check all that appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof i; j Roof pitch
Total Sq. Ft of Construction: 3 OCL Sq. Ft. of First
f Floor:
Cost of Construction:$ -r Utilities: ( Sewer L=.1 Septic Building Height:
Name �&i),00ll nfwk) TbEx Name:
Address: o2W6 S ) ��,51lo12.E: AL.VD. Company:14,An-,r/IRZ 'RUyfsflIF�y .47DtaG=
City: -AMT Jr LILT State: FL Address: )46/ 58-5, !U i e"eN edc Ci fcl e
Zip Code: _�S<gPY Fax: City: �6f-7 a LGIL7'--- State:
Phone No. `77a-0/5- !zj'l0' Zip Code: _-)Vg69 Fax:-Era-3 55-q5s y
E-Mail: Phone No. ?7a— 33 S-955y
Fill in fee simple Title Holder on next page(if different E-Mail: D,j5KCR,aI P_0ARDrlh9L9jDA0,f, C<Srn
from the Owner listed above) State r County License:
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 thepermit 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 Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/L'ce se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _jT LUCK COUNTY OF -:)'/ i-L4CIC
The forgoing instrument was acknowledged_�efore me The forgoing instrument was acknowledged k efore me
this(�Pl day of RA�c if 20j_� by this b+I I day of 1`914 iCIL'I1 - 20k by
Name of person rpaking statement Name of person making statement
Personally Known i OR Produced Identification Personally Known /OR Produced Identification
Type of Identification Type of Identification
Produced Produced
_ t
i
(Signat re of Notary Public-State o lorida) (Signaturie of Notary Pu"151i -State of F rida)
ottAY'�e�, DENISE LEWY
Commission No.G 7 376 §em4cOMMISSioN#00077 Mommission No. , �n r u�� ELEMAY
Nr� oe EXPIRES:March 23.202 *MY CbM�M�ION#GG 077376
t or r°w Rondec Thru Budpot Notuy °� o� EXPIRES:March 23.2021
1. �F Op
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17