HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: ,r A Z31Z�( 9 Permit Number: O05��6� 1
RECEIVED
:J
Alan' MT 2 2018
Building Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
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
PROPOSED IMPROVEMENT LOCATION: /'
Address: /�yflG����f3f u,t� �/ ?�� C /�� Z4//yl G/ Z
Legal Description: RIVERSIDE VILLAGE UNIT 3-4 (OR 4035-2127)
Property Tax ID#: 4426-510-0020-000-2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALL (19) IMPACT RATED WINDOWS AND DOORS
[CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit—check all apply:
HVAC Gas Tank Gas Piping Shutters L`l Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 40� � .� Utilitiest Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name e 6th O/ Name: - -:Vr\0
Address:/ /d G Company: /1
City: C/A/ State:FL Address: {h
Zip Code: 34990 Fax: City: IVmO�) r�n� S te: �C
Phone No.772-301-0287 Zip Code: Fax:(c3 S(J)
E-Mail: Phone No. to a
Fill in fee simple Title Holder on next page ( if different E-Mail: ,n Y C LLCA.
from the Owner listed above) State or County Lice 1 45�4 I 0
C alb 9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X 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 Commencem
c
Signature of Owner—Lessee/contractor as Agent for Owner Signatuof Contracto ice
t Ase Holder
STATE OF FLORIDASTATE OF FLORIDA/
COUNTY OF i?AL.1't'beaa- COUNTY OF �.-o a.J4t
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged t2efore me
this- ay of 20A by this Z I-day of 20/S[ by
Name of personj�aking statement Name of per making statement
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatu Nota li l a o FI ri ) (Signa Lft ySRl* cof*fKNI ii a
A F�S •= Commission N FF 993393
N b t I J
Commission No. •'o`a °%'•, Notar u c-S
WARNER
of Florida Commis rY °rte My Comm.Expirea,Jul 2(4����
• .•E Commission#FF 180664
+. P My Comm.Expires Dec 19,20
tinnaed throughtional Nntary t
REVIEWS FRONT ZONING UPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
y o° NICOLE S.WARNER
+°. ¢t= Notary Public-State of Florida
Commission N FF 180664
11 P
Expires uec
Bonded through National Notary