HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -28'— 7-01 �n(n_Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services JUN 2 9 2 01 8
'Building and Code Regulation Division ST. Lucie Count P
2300 Virginia Avenue,Fort Pierce FL 34982 County9
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: 1,,,, W/-/.. P 47- Si Luc/.e-, /1:7;1- 3 YPd1A
Legal Description: _ ��� 2-<.- 7- T C 9E-5C✓�L)C ieC PC_47' (f P12CUf ?a
Lo T /a6
Property Tax ID#: .33 2 7 ^711 — 00 f b ^Ooo -- 6 Lot No. /O
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION 'OF WORK .
,.
G-`Z 6—L,7,C iu P'TG> /V
CONSTRUCTION„INFORMATION
Additional work to be Derformed under t is permit-check a apply:•
HVAC 0 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric Plumbing Sprinklers OGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 9(�D- Utilities:Sewer[]Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name_0 1 CL./4-j-4 P W I LS o,i Name: -T/4q" or&-c
Address: 802,S'- L/ IG WA-1 Company: ' At l- C*4/0 So L(-L' f0sJS
City: to2z S'f Lu C i L' State: (`^C_ Address: _�.C7. 60,6 (p
Zip Code: 7,Y'?cP6 Fax: City:�CC( .S`4C ,?<,0 y State: PC—
Phone
LPhone No. 77 Z - `1 Zg- 2F 2-f Zip Code: 3Y9%" 2 Fax:
E-Mail: L,o a w/L.r o-J /9,& (,eq /.1a[ .root( Phone No.-_77 Z 2 2 t,- 7-- 77
Fill in fee simple Title Holder on next page(if different E-Mail:_Q eme-ei 4c/..i41 c w 7-/.j.S e X,14ci. Cc+�-1
from the Owner listed above) State or/County iLicense: CFC/V27"S_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM�NTAI C�NSTRUCTt4N LIEN l.AW I:N�ORMATION; ` ' .>.-
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 clothe 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.
Signa of ner/Lessee Contractor as Agent for Owner Signa a ontractor/Lice se Holder
STATE OF FLORIDA ..J�" STATE OF FLORIDA
COUNTY OF COUNTY OF
The f mg instru ent was acknowledg efore me The f g instrum nt was acknowledge fore me
this ay of 20 by this ay of 20,�by
Nam of person making statement ame&pers9h m king statement
Personally Known ,� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Pr ced
(Si nature of Not ubiia"flgYe o for 0 L GIL ESPIE (Sig ature o N
;,r P.•�; Notar Public-State of Florida ;o�i�11j�a ,
moo* a' �P '• MARGO L GILLESPIE
Commission No. * Cogff Nlion#FF 191045 Commission No =r' ��'S Notary Public fSbad4 of Florida
My Comm.Expires Mar 31,2019 Commission #FF 191045
'=S �' My Camm.Expires
Bonded through National Notary ASsn. %'�OFF1 � Mar 31,2019
'•�/11111\\
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17