HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' I Permit Number:
REMED
_ J _
• Alan JUN 19 7018
Building Permit Application PerSittiingipeepoa amen-
Planning and Development Services
untv
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: V' i u ��� I L c
Legal Description: �..i;1 S [i.} o-til nna Club &--,l 1q d ltd i Pei Li:[—LI!
0-3\k 31 LO:r LAS (Ilil 3-1 �KI -19Y2)
Property Tax ID#: pt)[-) _O(x)=a Lot No.�
Site Plan Name: Block No. 4_1
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
seer Iy
�Lw 10
CONSTRUCTION INFORMATION:
Additional work toe e orme un er t is permit—check a appy:
HVAC E]Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
U Electric 0 Plumbing Sprinklers El Generator 0 Roof Roof pitch
Total Sq. Ft of Construction//: SFt.of First Floor:
Cost of Construction: $ t—I y Utilities:11 Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name -Si i C 14 h,. ;U1 ic_h�� Name:
Address: '6U 1 l i,)a D�^ Company: ekht Q 1t a, Att," ' ;a �
City: PS t-- Stater Address: I �Nk I a(Irl�`lye
Zip Code: 5 Fax: City: �-��i a;yy-CL_Q State:EL.'
Phone No. 1� - `1 15 Lgo1q1 Zip Code: _ LA `� I Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:C��riC�v_[�� z CAI 1 Ctif- �� � C.Cti'Y1
from the Owner listed above) State or County License: L,lam 1�I%E 11
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 thepermit 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.
ture o e essee/Con ctor as Agent for Owner ature of o cto t e Ho er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF tA. I
The forgoing instrument was acknowledgedefore me The forgoing instrument was acknowledged before me
this 1 b day of Sl.��sz 20! by this_Slay of Swv`Jc. 201'� by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature Notary Public-Sta a of Florida ) (Signature df Nota Public-STAUe of Florida )
►+rV� Notary Public �Iflonda
CommissionF�Z')
a Commission No. �tg lI
ry Pablic State o Flontla Ysia G Sny gr`
is G Snyder ; • My Commission GG 225634
My Commission GG 225634 sop�� Expires 06/0612022
REVIEWS FRONT I ERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.8/2/17
LR7