HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED eo ' v�0
Date: '"I b'r` g P rmit -
D
J Ju
UL 16 2018
Building Permit Applica i
Planning and Development Services Permitting Department
-Building and Code Regulation Division St. Lucie Co nt r FL
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:2yo 3 S �L. /�-� {� �' b
Legal Description: 19 36 `I 15 175-. 10 E, o-E G,04 Ly& &5- o-C
Property Tax ID#:
_?L _0 �// y DD/D� Z 0007 Lot No.
Site Plan Name: ' /tic il^4"X i/I�s)'c�n �-c Block No.
Project Name: �tcr� y� Iod�enc�c
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe performed un ert -checkispermit a appy:
[JHVAC 13 Gas Tank ❑Gas Piping _Shutters Window Doors
aElectric ElPlumbing Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Z G 5� Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name U14 Name: (lor`41s T.)ckaA
Address: `� 3 0 3 S T..GI l A� ���w -� Company: L`ba,�
City: �or�r'i e�� State: Address: A&A, ( 5 L .)D on;n C.."fi �
Zip Code:SLt"Z Fax: City: e,-fu"'r State:_EL
Phone No. 7-I'l Z (a /5Z-`'( Zip Code: 3 Lt9 `7 Fax:
E-Mail: Phone No. -)'I. J6 1
Fill in fee simple Title Holder on next page(if different E-Mail: LJb f?_ �"�` I G &_4'5 C--Z) M
from the Owner listed above) State or County License: L c- 7_l W 6.3
G C- 1 5_% s
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTIQN 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: _ of 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.
000,
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE'OF FLORIDA. I STATE OF FLORIDA
COUNTY OF MaT,,v COUNTY OF ^9 p, �
The forgoing instrum nt was acknowledged before me The forging instrument was acknowledged before me
this 20' day of Er)cr ,20 IS by this.14 forging
of 20113 by
Name of person making statement Name of person making statement
Personally Known )� OR Produced Identification Personally Known Y OR Produced Identification
Type of Identification �!l�1914PIEIl�ry�o Type of Identification `N999111111P1/l�/06
Produced `��� p�tLAM.Cp77��i�e Produced A�����. OFILA�U/�Y�i�s
O
emlber/�'1'T•,�//� _ �} Q emba,vL°L��N y
(Signature of Notary Public-State oWda JIFF 157 �''E= (Signature of Notary Public-State ott�a F1S �ye
�z> 361 •. 1
16
Commission No. fIs I 8(yl un '�pQ��� Commission No.FI' iS143fo1 �l��( `erc+ e;: "0 ZZ
01111
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17