HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: if la
5- - � RECEIVED
Building Permit Appl,ication JUL 2 6 2018
Planning and Development Services ST. Lucie 09dnCy, grmitting
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 S
PROPOSED 11MPROVEMENT LOCATION:
Address: 6 Son Cor`- SqV jt- Loge_
Legal Description: SAi Luc l e P (ccZCk_ b JA.t onie- [71r5f a II Lot Z7 0AJ
Property Tax ID#: 412 9- 7 02-- /3 Y3 - v®n Lot No.
Site Plan Name: b�6 9 d() LAI� Pa r4 SR cA4 LcJG[(Z
/� Block No.
Project Name: Ems' 1�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION. OF WORK: a
V) tA 4l _�O .911 c�SIe, T
e� +
CONSTRUCTION INFOR'MATI'ON: .
Additionalworkto be performed under tispermit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11Electric ❑ Plumbing Sprinklers I Generator [ I Roof �Z Roof pitch
Total Sq. Ft of Construction: 2-,3 o O Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer Septic Building Height: �O
OWNER/LESSE-E . CO:fVTRACTOR:
.g ... _ .
Name -Ma S'e) r,\ /V",q\ i^ Name: 010 A DL-P-M Xi+eQ
Address: 2 cd(o$ri Vj rxw Company: Ac-Q- ,Pry ,00F8Q 6
City: LO c i-2 State:_L Address: 9 L4 7 n CSC Gtr
Zip Code: 3 ' 'Q 4b Fax: City: S+ a IPcl-Gl1 State: L-
Phone No. 55 (" ZS-Z- 0E-Y5( Zip Code: --?? qo q Fax:
E-Mail: l(a f0l)C"- AO C-'"O( t Cc71" Phone No. 5-O 1— 3 1 -7 5-1 PC
Fill in fee simple Title Holder on next page(if different E-Mail: �O Le rO oW_ CoM
from the Owner listed above) State or County License: f L S'-Y&+Q
CCC 1 IT08
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN `LAWIN'FORMATI:ON: .
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 Counter 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/Lessee/Contractor as Agent for Owner Signat f Contrac or/License Holder
STATE COUNTOY OFORIDA 1 ��1� COUNTY OFORIDA
l_ ��� b rig
The folT�g instrument was acknowledgedpefore me The forgoing instrume t was acknowledge
ch
I day of �yll I�- 20 I by this day of 20 ��before me
by
-GQ o n (M(A I p2. n —
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identificatio��
Type of Identificatio Type of Identifica 'on 1tt
Produced Y) I f S (, l Produced CV�f rS U 0Nt-'t
(SignaVuro ota lic- (Signature of N y Pu icfffdMN0I`a�ic state or Florida
h o to ublicstateof lorida Isiah Jorgenson
r My Com �GG 209624
Commn No. Cassid ommission No.
C� (-7 �� ��( n �nf Expires 07/11/2 22 GG 237306
REVIEWS FRONT ZONING SUPERVISOR ' PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17