HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: o Permit Number: O, all I
Building Permit Application JUL 2 7 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
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 IMPROVEMENT LOCATION:
Address: 5313 rvRr P11;k(6 f=1_ 3-v 91-2-
Legal Description: .ZN I ER S TeS 'UAd 04 -(31,K
C 4AP 3Y/6�2 S) (on 2'02 - 2565 )
Property Tax ID#: 4 0o " S Lot No.
Site Plan Name: X313 14iGkoglj .DMZ Block No.
Project Name: ion-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
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Additional work to be performed under this permit-check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers O Generator _Roof s Z Roof pitch
Total Sq. Ft of Construction: q ��r� S . Ft.of First Floor:
Cost of Construction:$ l ooL Utilities:CnSewer ElSeptic Building Height:
OWNERAETSSEE: CONTRACTOR:
Name FJ%1v i 0Y:-_t Name: JWInl C49J'-_J !;tV��
Address: S_31.3 LhCkVa7 I)R Company: � � � 661yT144LZyz4
City: iy4:7 pu5n(a L State: L Address: '51V, x6MAR(Z' 0`9 ki)
Zip Code: .�N� Fax: City: W ilu7ir,-a- Sfa6k� State:
Phone No. qoo Zip Code: Saw. Fax:
E-Mail: Phone No. $13—
Fill in fee simple Title Holder on next page(if different E-Mail: rj�,aborf/V(4-p- G G�M��.1.• (;aM
from the Owner listed above) State or County License: cGG 13 316 P
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. %eJ1 q a
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: te: 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 bFftM
orded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consultender or an attorney before
commencing work or recording our Notice of Commencement.
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gnature of Owner/Lessee/Contractor as Agent for Owner Signature of Con ./ ense older
STATE OF FLORIDA / STATE OF FLORID
COUNTY OF c S��/1�i ( �-- COUNTY OF
The forgoing instru t as acknowledged before me The forgoing instru nt was acknowledged before me
this 2i day of 20)by/ this 'Yday of 20 ff by
(7Name of person making statement Name of person making state
Personally Known OR Proclyred Identification '� Personally Known OR Produced Identification
Type of I ent' 'ca bna Type of Identification
Produc d / / r Produced FiA c, SSZS- N2.3 -s-9-303
(Signa ure of Notary Public-State of Flo ) (SIE! ure.o Notary ub�l ate of Florida
Otdl}IPUbIIC �i°�a 'Jo WILT-IAQWADE JENNINGS III
Commission No. S%WOf Floddg Commission Ni Not�ry��u�t�rl�-State of Florida
MyCommission Expires f)3115%1019 :Nr• com issio # GG 023125
CommissionNo.FF209709 OF FL, My Comm.Expires Aug 22,2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE -MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17