HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 as Permit Number: \$Q�S-O S,
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Building Permit Application RECEIVED I
Planning and Development Services MAY 2 2 2018 l
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 I Cp,,,, permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re! -
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 134(11� � )' 16111;irl P11bL_)r_ 1;i`VD-,
Legal Description:
Property Tax ID#: 436 QUcoo - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�r7C�tEn�—P.�L��TE r=..1(��{T� ,ADD � RFCr✓� C/arNS�Ke✓�t1��F �w,;Tia� �'�+�'nl'�r. SvJ�2��S
Mtfll ��71— )tJ I�rrClt .
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
❑HVAC Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�-7� a� ln.J
Cost of Construction:$ /6U Utilities: SewerF_1 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 171oQ, Name: K7pur' J5_7MGFLN1'9PJ9J
Address: _ __ Company:A ecup-,iTE Egi:-rkiclil Cort Rnc-216, mac-
City: IJgWRJ,�_T JJEIA)S State:J Address: 7/73 G9111071 PL-
Zip
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Zip Code: 360 1 Fax: City: Pg-r ST Zuele State: FL
Phone No. 5-6L92,2- /37J Zip Code: 3475-a Fax:
E-Mail: Phone No._ 77,�_- 370---575_5
Fill in fee simple Title Holder on next page(if different E-Mail: A(CU.2A E e-L EC I,0C.f Si, eQU-rW09, CCrl
from the Owner listed above) State or County License: CC CC0 30 1 o?
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 thefir inspection. If you intend to obtain financing, consul ith lende r an attorney before
commenci ork or recgoing your Notice of Commencement.
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Signa re of Owner/ /Contractor as Agent for Owner Sign�fure of ntractor/License Holder
STATE OF FLO A STATE FLORIDA
COUNTYOF COUNTY OF
The forgoing instrument was acknowledged bgfore me The forgoing instrurllent was acknowledged before me
this day of ,20 by this day of �/� 20�yby
Name of person maki statement Name of person i1naking statement
Personally Known ';"\ OR Produced Identification Personally Known�A OR Produced Identification
Type of Identification Type of Identification
Produced Produced
�) G� S C.viRG,���i,�� C. vJR�'IUyyy
�0 ��i /f PZ�i1e uy ,ZXp
of Nota Public-'State lod .�
(Signature of Notary Public-S e a�Flgr�uf, ` �� Z (Signature
ry Z
Seal '• '* Commission No..11 _ (SD0 '
Commission No. - ( ,otaltei s Z y urtor
0�'/ t, di R% ��� �ic S..• �F \ANS
REVIEWS FRONT ZONIN���i��f; �SOR PLANS VEGETATION SEA TUR�1!�/ql II1�bVE
COUNTER REVIEW EVIEW REVIEW REVIEW REVIEW EVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17