HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date:
\-I 1 Permit Number:
• �_ RECEIVED
Building Permit Application AUG 0 2018
Planning and Development Services
Building and Code Regulation Division ST. L-�a�ie co fly, Pflrmltfiing
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�a►b
PROPOSED IMPROVEMENT LOCATION:
Address: f) d,2 Tc.
Legal Description: J Q C � L� UT Cr /J�/ Q � S Jn
1 y Liss yv,l� T / o�f' 0-4,41//�y L RA/ ' L1�
Property Tax ID#: 302 b IVA 7 000 O non cD Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front. d Back:. `�o Right.Side: ,V LeftSide: l>
DETAILED DESCRIPTION OF WORK: .
jar
Rig C,�L O -P Ho Us/L ZS006 �vs / /-U 1J� qv-,9-
12 73 2 fb
ENSTRUCTION INFORMATION:
Additionalwor toa oerformed under this permit-check all that appy:
1JHVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ ��4 d,y7) Utilities:r)Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR
Name ykP,& 6-/0"o tl -2-Xi C Name: 6-?Mz 'o SUP
Address: PO IR Company: JA-16
City: 116AT 8 Tg C? State:)5�L Address:9� U10 v 1)L&!2 A S` y P 4
Zip Code: _< _ Fax: City: ✓oP_ Sj b i,01 r? State: Ir-L-
Phone No. ORO/ d ? 7n U_ Zip Coder 11 Id-.)- Fax: —
E-Mail: Phone No. 6/ -_:l 2 3 S'
Fill in fee simple Title Holder on next page(if different E-Mail:L/w�g U Rfi- /9 W 9,9/ i A/
from the Owner listed above) State or County License: C a 0, ) �\l)
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
hone: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 approvedplans,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 Cor�Jnencement must be recorded and posted on theJob,
before the first inspection. If you intendo obtain financing,consult with lender or an attorney j;b!fgrre
commencingwork or recordingour N i hof Commencement. / /'•/
l /
Signature ot wner/Lessee/Contractor as Ageerit for Owner Signature=FLORIDA
ntra r/License Holder
STATE OF FLORIDA STATE
COUNTY OF 'S)t, _COUNTY OF d �-, �c c2
The forgoing instrument was acknowledged before me The fggrgoing instrument was acknowledged efore me
this�day of J ,265:R by this " day of y ,204 by
Cs-rte, a c viy_' 60'rt. a t-3 A fAA)T
Name of person making sta ment Name of person making sta ement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification. Type of Identification
Produced Produced L- �L
(Signature of Notary PubV--State of Flori (Signature of Nota u tate of 99fi ►)UTARIE GIVENS
Ns
NpM�I#GG 0023 = •• •= MY COMMISSION#GG 022023
Commission No. �SS10N 2020 Commission No. �� EXPIRE$LegQ bet 16,2020
' :*c MF)CPIRES:Decembet16nd lets %;;k o?•' BondedThruNNotaryPublicUndenvdters
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ublleU end •°
REVIEWS FRONT— ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17