HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
JUL 0 2 2018
Building Permit Applicatio
Planning and Development Services ST. LUDIC C_u (I , Permitting
Building and Code Regulation Division -
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential J_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATICI
Address: �y(7t� ober 0cl Fort Pie C-t , 3�fgSf
Legal Description: La.1 �d PcLt14 _04%r
Property Tax ID#: 1301 -(_o0Z- O 11 t -005" ( Lot No. 1�
Site Plan Name: V01-3k Block No. 1.
Project Name: VO1�t
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
oY� asphalt sh�rojles �� sysjewl CA r4
1ns-1�11 asp�n�,.1fi Shi rile raaF sy5i , , FLS �Oc�-►�
p11 c FL$► l 232 — Rg
CONSTRUCTION I_NFORMATION.,
AcIditional work to be nertormed under tispermit-check all appy:
HVAC E]Gas Tank []Gas Piping _Shutters Q Windows/Doors
11 Electric ❑ Plumbing []Sprinklers ElGenerator Roof 512 Roof pitch
Total Sq. Ft of Construction: 120 SFt.of First Floor:
Cost of Construction:$ y,10� Utilities:12 Sewer Septic Building Height:.
OUVNER/LESSEE: _ CONTRACTOR:
Name Jon V0,1# Name: t C)Won Je.
Address: ql-IO(o (Luber Company: D illo ppFj LL-C.
City: 90(4 P`4e_'(tX_ Stater Address: PASS) SE G3mpe. wd tNvt.
Zip Code: 34951 Fax: City:Port 51. umc-►e_ State:FL
Phone No. (-7 t 8 ) 6 1 q- CD 1 0 Zip Code: 34C152 Fax:
E-Mail: Phone No. C I I?-) -113- IZIU
Fill in fee simple Title Holder on next page(if different E-Mail: C(I I(OVI(bd f i YtG l 16 @i ()%)t 1061C •COM
from the Owner listed above) State or County License: C.(-e 15313y
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/Lesse nt icense Holder
STATE OF FLORIDSTATE OF FLORID
COUNTY OF -uCOUNTY OF 4k L-u CZ,0�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this as day of *A&_. ,201& by this ZZ day of +1A__
,20$ by
Name of person making statement Name of person making statement
Personally Known'—OR Produced Identification Personally Knownli OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sig of Notary Public-State of Florida) (Signature of Wotaru P fh
dALLY MEISNER
Commission No.lEaZZOMMM.—
SALMMEISNEN Commission No12
. .`'� �'o o� 11lorid(Socii)ry Public
e of Florida-Notary Public + �6nnlisslon #GG 192960
ULU
mmission #GG 192960 3 my 6'@mmisslon Expires;
y Commission Ex i�os i i MtlPOh.06, 2022
REVIEWS FRONT ZONING 1UTffffX7ffM PLANS VEGETATION SEA TURTLE MANGROVE .
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17