HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / / (�
Date: 5/21/18 Permit Number: ! �s�b�O//
CDCJNTY RECENED
r iL O R.. I. D R •-
Building Permit Application MAY 22 2018
Planning and Development Services Permitting B
Building and Code Regulation Division 9 e art
Wgle IreyR�'p
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3110 Oleander Ave, Ft Pierce, FL 34982
Legal Description: MARua \»-LA (,A-/J Sb -UNcS C (9r K-b R r ,� r-r
' (1,31- s vv.) Fi . ";t;L 'icS N -F� , Tia f'c (ntl 2'L(. - 1-313)
Property Tax ID#: -6 D 1- 000'-- O0o- 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
100 Amp Temp Pole for Remediation sytem (Permit SLC-1804-0163)
•
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit-check all apply:
❑HVAC Gas Tank ❑Gas Piping Shutters U Windows/Doors
ElElectric 0 Plumbing Sprinklers El Generator El Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 1500 Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name -Te;4 l A/JD Wry-NT i C era Name: BUYu.v;
Address: Po kjk Lh0\-) Company: ?%o1Ati� (JAIL-(1 .Ic •N9auy?. IrA-
City: eC.o11---s ll nt State:VL 2. Address: ( -i i41 M. .iQ3rts
Zip Code: ;;c l 1 Fax: City: / y.n , SNix.)- State: FL.
Phone No. Zip Code: 31.1')\ Fax: `10-1- P93+f- 1711
E-Mail: Phone No. `�� 3`�' 2315
Fill in fee simple Title Holder on next page(if different E-Mail: i,�'P� ��o.. r ti r'o' c I-
from the Owner listed above) State or County License: tE.C.0003t13
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:3110 Oleander Ave,Ft Pierce,FL 34982 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 your Notice of Commencement. 7—
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contracto/License Holder
STATE OF FLORIDA 4 st-1-4.444 STATE OF FLORIDA
COUNTY OF COUNTY OF (p-\ )oLe
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L -day of .ii ,20 I5' by this Z'L day of 'il ,201 by
'l kVA,- 2v9a5'oi' 1Z vut., tCi>,lLc.,,v,J M.
Name of person making statement / Name of person making statement 7 ` iPersonally Known OR Produced Identification \/ Personally Known g OR Produced Identific. ioa••'`"
Type of Identification Type of Identification i;
P .duced '(.I 0 Produced a Sq,a
m 3 r--°
��I rl /� I �t[�.f �, o° oto
r" (Signature of Not Public St.te of Florida) w...
Hatt re of Notary,<, ub(IGn of Flo?ida:J ,_. Q
ot,e� a LASi1AHNa INC,ggM I /t q -"
Commission No. } =? °" Nuiary{Sell)-State of Florida ' Commission No. Ah 191)221 (Seal) u a
,1 :� �, :Pny Comm.F�pires Dec 20,2018
P�
''",5 i`oa' Commission;'-
state
FF 177249
_Bond201voiary Assn.
REVIEWS FRONT ZONING SUER\7TSOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17