HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `] Permit Number:
RECEIVED
Jk A
MAY 17 2018
Building Permit Applicatic n
Planning and Development Services ST. Lucie County, Permltklfl9
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _ V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Roo 1_
PROPOSED IMPROVEMENT LOCATION:
Address: UCO C_4;),rich T(� r a r-(• IC1ri12
Legal Description: C.c,`,& i ho C&p(-k kcf:) - \o1 w✓ 853-I�11,
Property Tax ID#: 2-q c-) O(::)7:z--Cr-,n -- Ft) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
[CONSTRUCTION INFORMATION:
Additional work to be performed under t ispermit-check all apply:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
1 Electric Plumbing Sprinklers 7 Generator F] Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ c7Z'1 V V Utilities:Sewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name - Vi V ►c-f- Y-c-I9 ck Name: J�rr�1 �,� i 11 ;c�►-��
Address: Zai e__tce_L lc-44 C Company:_,\oQ:)A
City: 417- Stater(. Address: S
Zip Code: 3 L(c19,` Fax: City: � State:
Phone No. ',1 --- `/G14- 5Zip Code: 13q01q S Fax:1YZ-577- L42;q6
E-Mail: Phone No.'117--"t%9 - 133 3
Fill in fee simple Title Holder on next page(if different E-Mail: -tidci(c;,curc R;r!Sp
from the Owner listed above) State or County License: L'DL 144 57 e4 3
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 our Notice of Commencement.
n ure of Owner/Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORtDA
COUNTY OF �jk_ LO c Q COUNTY OF S LUe
The forgoing instrument was acknowledgel�,before me The forgoing instrument was acknowledge before me
this day of V`n��) 20� by this day of Y^��I 20__M by
dr6o `(N s, N' \ a� `1aba-'\ W % kk\O►Y%4s
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
ProducedProduced -L—
(Signature of Notaryublic-State of Florida) (Signature of Notary llc Sia 'ofiFlopp
weavam�.,u tssn ua a.ru�s z.r :::a.s•- U' A MARIE G3,
'41P�;.,, NA R1 u'!E GIVti 5 - MY COj�VA41S ON#Gi.
Commission No. �S �: (Se Commission No. EXPIrg
MY C MA413SiON#GG 02202' tuber
-,tc �'c Bonded Thru Notary Public
bra; EXPIRES:Dsrember 16,20'LO
:}0.8�°:° Bonded Thru NotaryPuciic Jraerxrl r:
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17