HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (� - C� Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services JUN � � ZQ�B
Building and Code Regulation Division permitting
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County,
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Window/door
,PROPOSED IMPROVEMENT L'OCATIt3N
Address: qqk �1 �1�1� .� in"� r�e l� zzlde
Legal Description �l�f� 0,L) �S�'�'t� Q►.9 ^ Ltl 4>6 -UESS 1 � 1 ,03
r�
Property Tax ID#: 5 f - S66 - 00.86- 060-6 Lot No.
Site Plan Name: _n Block No.
Project Name: '�Ytki.� '� t`0 �.9Cr� �tt�4✓�C�% w���b'1��
Setbacks Front Back: Right Side: Left Side:
DETAILEd DESCRIPTION OF WORK ,
.5IZ,� Sfti-as, UR-r.- L DC6Y . i��vz l-c ��U UP.-fou--f -Ng�-2.
ULA V0✓�-t iz6 `I-e IZ
CONSTRUCTIONf,I'NFORIUTATION
_.
Aciditiona I wor to eperformedunder tispermit—ceca py:
❑ p
HVAC be
Tank Gas
Piping _Shutters Windows/Doors
11 Electric E]PlumbingSprinklers I Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �� It` ,�� Utilities:n Sewer O Septic Building Height:
'"NER LESSE x�CONTRACTOR
Name ` Name: vakt4 A-6
Address: M KJ �� - Company: ° l4 6X133 \W,��2C�Jo 1SS-Q
City: "V-P State:,, Address: -'&4A Sw zl O
Zip Code:��g5rl Fax: City:_'�-t uIrO i SV-61atc State
Phone No. ` Zip Code:' -�31'L Fax:
E-Mail: Phone No. OLC74 s-ICt(Z-A A-15
Fill in fee simple Title Holder on next page(if different E-Mail:?i�t.'tS QVAA R"J('-cS ,caps.+
from the Owner listed above) State or County License: (!,GrC,-6CoLsctc
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION"LIEN"LAW IN>=ORIVIATION
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 Commenc m
a 2,MeA�S2 I &tnr� VM% . —
Signature of wner/Lessee/Contractor as Agent for Owner Sig uNOF
ctor/License Holder
STATE OF FLORID - L STATDom°►
COUNTY OF &w��G (,NGr`(, COUNTY ` WC-11F
The forgoing instrumen�t as acknowledge efore me The fg�going instru ent was acknowledged before me
this I Sday of S .201tby this 9 day of 20 ehl by
JZ&CA 1`Y, SP&CG Ire
Name of per on making statement Name of person aking statement
Personally Known, OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced It A Produced
14-1
(Signatur is-state of Flus iu ign of ry P is tate o W&J�A
6�1-4
MATTHEW BIRKI S :; .,w MYCOMMI 'WERCA®O
Commissl�-, 'c MY COMMISSION#066210448 o issio N EX?IF��gat #CC095745
' EXPIRES July 02.2021 ri!19,2021
REVIEWS FRONT ZONING SUPERVISOR NS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW RE _--REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17