HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: S a`3 Permit Number: iIACj5-oG
RECEIVED
Building Permit Applicatio , MAY 2 3 2.01$
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
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
I PROPOSED IMPROVEMENT LOCATION:
Address: 9n� OfoDI7 ac, z&z T #O (a ien Sen 3q J 7
Legal Description: LE-5 p \1; I I cl-61e p142�e f ZLl 7 (,d{' d- 9k
Property Tax ID#: ?)535- S33 -0001-5160- 5 Lot No.
Site Plan Name: J-0 h/7 R�,Mn/� Block No. Q
Project Name: jo-ho Fe-zfto
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ro
l� plac'e
14 7T 1� "4032X-/ 000A l�-ln�o See
TOM 4A0 5ISA
CONSTRUCTION INFORMATION:
Ledo a workto e er orme un er this permit-check a appy:
AC Gas Tank Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Ei Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ .000r Utilities: 0 Sewer 0 Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name-,722/7 & Name: T C. 6?-5311
Address: g �/ �� DCeI//'7 .�/' �li���'� � Company: C "-I }yZv
City: LT'011 seo Aeae h State: FL Address:
Zip Code: 34 I57 Fax: City: &-o era dea,-A State:_EL
Phone No. o/-&/• W- 3/92 Zip Code: Fax: ` 3- rS3QS"
E-Mail: Phone No. 670/- C)ct a 3a
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION ", Y.
DESIGNER/ENGINEER: 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.
X
Signa'tafe of Owner/Lessee/ ractor as Agent for Owner Signature Contractor/License Ho der --,
STATE OF FLORIDA p / STATE OF FLORIDA /� �l.� L
COUNTY OF f a/r!'J ��P/L( � COUNTY OF 4
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged efore me
this 7 Z_day of L 20�by this day of CZ 20aby
hn C, �Q ss��� �Ti2 :%v/� c. ��ss;ply ✓,� .
Name of person aking s atement Name of person aking statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
h�r n
(Signature of Notar __ (Signature of Notar ata (�
i
RA SHIPP-CINTRON T RA SHIPP-CINTRON
Commission No. W
mn) g # FF 170014 f � �, F 1700i4
_ ( atth Commission No ommisMy Commission Expire; ' ° �` : My CommissionExpire.s October 20, 2018 :;,"`°�``� October 20, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17