HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Y�
Date: lli ' 21- I Permit Number: t/ 2
s : RECEIVED
Building Permit Application JUN 2 0 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 . St . U C I e County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial V/ R
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED 1PROVEMENT LOCATION:
Address: PW SCS-t 1 6c ecL,1 JV Je, J&1scn Beacr'!_ (L^ .31' q5-
Legal Description: C)L)tdoOvr 1,25uv+ ok IVeT I leS IS10-Oc! `1'� (o, '+ttQQ.S
Property Tax ID#: '450z- 501 Ooo o- 6oci jo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
exp ta u� eau SV-)� S 11 d t( c,�-i �V\� n{w SI i c.e v -- t-S f 7v c tb r- c-4 c ti a,�,Y.c
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CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC E]Gas Tank []Gas Piping In Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Constructiont:2 S Ft. of First Floor:
Cost of Construction:$ I S�•� Utilities:Sewer F]Septic Building Height:
OWNF�fR,►LIESSEECONT CTOR:
Name rJe+F�e�s I.yjQrld. �t'lf,. Name: /1"
Address: '1901 cSCyj 0+✓eah �iIVd Company: v CA _2>6 I�YNPI, &V-D•
City: , Q ctC6 State: FL Address: 1102. N ✓D 1t Waij
Zip Code: 349674 Fax: 7 2 ZZ - 01 City: 1?�}- S�• wd e State: L
Phone No. '1-12- 22q- 293D Zip Code: ARIL Fax: 112-(o2 1-7 L9 31
E-Mail: �QIUr Jnel2sisl0.v�dca�,c�o.GOYh Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: C Y Y + Vv)o►. - WM
from the Owner listed above) State or County License: C C 7_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
a 0
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.
— cz_)�Cfn — Ci_
Signa f Owne Lesse on s Agent for Owner Signature of Contractor/License Ho
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5-r. Likc-(E COUNTY OF Srt, LLA-ct E
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this of day of - Lur\e 2011g� by this 20 day of 20 1$' by
Onc'i5 tAc�3o,n-e.\\ G�'r-;s
Name of perso aking statement Name of per,Son making statement
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of No c- ate of Florida) (Sign a of Nota u -
F(4407;)
;�4; u ' RKIEWICZ
DAVID J_1 WICZ c MY COMMISt FF998909
Commission No. Commission No. : • yI
MMISSION#FF9%909 n • EXPIRES June 05,2020
.,. EXPIRES June 05,2020 (407)398-0153 FrondallotarySenke.com
398-0153 F�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17