HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: LD }X"' Permit Number: G� °b
RECEIVED
" JUN 19 2018
Building Permit Applic tion
ST. Lw8ie OotintY: 13vrmlwn4
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentialy
PERMIT APPLICATION FOR: i l<s
PROPOSED IMPROVEMENT LOCATION: ,
Address: Z�—� l v-L- c_ lL— L ✓� �'� l e f(-D, =1 �,�/Sc�1
Legal Description: r1t I� n' J
Property Tax ID#: U 2 y L414 n oC)- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
i O c
Sh � .�� ,..., co
c PQ�� N s c�
[CONSTRUCTION INFORMATION:
ditiona I work to be pe rformed und e r this permit-c eck aF�at apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows Doors
Electric _ Plumbing _Sprinklers _Generator L___I:r0_0f Z Pitch
Total Sq. Ft of Construction: 3l2 Off' Sq. Ft. of First Floor:
Cost of Construction: $ Z_D Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name-DCc\C\-LS I(\E-� Name: �( �L _
Address: e�ZZ� ` L LT(- Or' . /L L-✓` Company: £ CJ
City: . l 't if V- C_.Q State: r( Address: (.o S L_ v
Zip Code: J��'1-1 �' Fax: City: State:���
Phone No. Zip Code: _ l ( � �0�
n Fax:
E-Mail: Phone No -7 2'��-L �� Z
Fill in fee simple Title Holder on next page ( if different E-Mail (_ , C,h t� -� C'ctiC-1 �Ic rno�
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:
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 Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF '6 . t- COUNTY OF S k . L,je%P,,
The folgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this.\n day of 5 V nQ 20 by this 20 by
`\e.\V--Cel. '_�' '4& 'I r Ne,1\y
(Name of person acknowledging) (Name of person acknowledging)
u
(Signature of Notar)OPublic-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced IdentlficAtici , , : Personally Known OR Produce tion
Type of Identification �M..�,EGI�c Type of Idenf�eatigatt D�\NNa v,.,ltGlvEi,s j
Produced L - •FJ 2h .• DFS Produced - I
MISSION#GG 02202:1 G 022023
a erember 16,2020 !".
EXPIRES:d r.XPIRES:December 16,2020
Commission No. °= PcblicUnden++d�� Commission .; z .� �7 uNotary Public
ers
Bonded m � _
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
V.