HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 42) Permit Number: a
RECEIVED
• _ Marl
Planning
Building Permit Application
MAY 1 1 2018
and Development Services
Building and Code Regulation Division SLS ucie County, Permitting I
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: L CLO, l ie(4e-., riAa_ aL-t
Legal Description:'Ta
Property Tax ID #: 45)4 `� Lot No.
Site Plan Name: Block No. _
Project Name:
Setbacks Front Back: - Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK:
r �----- s
06-7
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 V/ Roof s64(2-4Pitch
Total Sq. Ft of Construction: 21060 Sq. Ft. of First Floor:
Cost of Construction: $ /,��/R Utilities: _Sewer Septic Building Height:
O1LESSEE: 0C1`OR:
Name z�- tv\ Name:
Address: VIA,L_ Company: K
City: StateR, Addres
Zip Code: 7i Fax: _ _ _ City: State: �C--
Phone No. 77 7J :7iH-Z, Jq3 q Zip Code: --, �0 Fax:777
E-Mail: Phone No 747Z`
Fill in fee simple Title Holder on next page ( if different E-Mail . lLt,c (.t i
from the Owner listed above) State or Cou ty Licens L
If value of construction is 2500 or more,a RECORDED Notice of Commencement is r uired.
I
UPPLEMENTAL CONSTRUCTION LIEN LAW INFORM
ESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: �� Not Applicable
ame: Name:
ddress: 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 8gree 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.
Sign ure of Owner/Lessee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF Lue .e—,
The forgoing instrument was acknowledgedbefore me The fqjpoing instrument was acknowledged-before me
this W day of_ao.4.4 by this day of MAC44 by
Nlga IAI -�_A&^- I lm�Q��6)
Name of4krson making statement. Name of per making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Pro uced
9
D
(Sig of Notary Public-Sate�4,�lQjida ) JAIME ORTIZ (Si a of otary Public-St;arp;ot,Florida) JAIME ORTIZ
1 1 1 `r= Notary Public State of F orida , = Notuy Public-Stott of Florid
Commission No. .-&(*)Comm.Expires Jun 1.2� ission No.�� My")Expires Jun 1,201
Commission FF 111 85 �•�, Commission I FF 111485
Bonded Tlxoi*National Not Assn. �'''•?".$4.1, Bonded Th National NNO(ary Ass .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17