HomeMy WebLinkAboutUntitled ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED- fl ��.
Date: L-161'�e Permit Number: /7°
yt 4 i
Building Permit Applicati • n JUN 18 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St Lucie 0 ' ty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ' - - r
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line eIbe-i-r re c/,
PROPOSED IMPROVEMENTnLOCATION:
Address: /e0 L IP!/ 8J.4-e,/ (.Ji;
Legal Description:
Property Tax ID#: 023/I`60/-O/Z4)-- LSGo`3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
- %Avi9 Mac,' ti 4.09 e. / 254'FS A 5 k je-
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit-check all apply:
HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
_Electric 0 Plumbing ❑Sprinklers El Generator CI Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 0M° Utilities:Sewer LI Septic Building Height:
OWNER/LESSEE. ,CONTRACTOR:.
Name Gorki/t-14 /2 oyer-}-i $ of SGL Name: a .4-1-e.Sk e
Address: l 20 R O e t<}w,m'e, Company: / " ' r.
City: rf• ei r Le. State: P- Address: j 90 y /44/...)-10 pc.1
Zip Code: 3 /cl5O Fax: City: eree/ State: FL-
Phone
LPhone No. Zip Code:_3L199 7 Fax:
E-Mail: Phone No. 772-2-a- 7297
Fill in fee simple Title Holder on next page(if different E-Mail:
o04tz
from the Owner listed above) State or CountyLicense: �G %� ,2-
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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature ofOwtSer/ ssee/Contractor as Agent for Owner Signature of Contractor/; ense Holder
STATE OF COUNTY OFORIDA �` a.-, rZi`e ' STATE OF FLORIDA ` �`
COUNTY OF ��.�O�� l �`( Q-i'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this `/ day of SL r•-C- ,201V by this it.-day of ()o r. ,201w by -
___---' r I
Y6 y G , Q r/P�id --r` 6 C( r v P-/' f-O
Name f person making statement Nam6 of prpan making statement
Personally Known \/- OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced • Produced
/
_�.ir�_— --. ._
(Signature of Notary Public-State 'i f,? "<).` JOSEPHINE O.A;o2f-6E
FL ' : e of Notary Public-St. Ply;..—.....—..--
i;::-.: )Notary Public-State of If to da
+�� Notary Public-Statelorida, .* +•� '* "' +•' Commission#GG 043.Commission No. - 4L3 ; '•" if
jk � Oc('2.3 �p -Z : ,. „—,q.-: Commission#GG t ion No. 2 ="A �� o;, _��+;oc omm.Expires Oct 2E,',f 201 ,484 FI„P' onComm.Expires Oc2020` ,,'48 �P 1
'"�����'" Bonded through National Nota y. sn.
”""""�• Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17