HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��-
Date: Permit Number:
E 771
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Building Permit ApplicationLPermitting
AUG 13 2018
Planning and Development Services UCis rime
Building and Code Regulation Division ucle ei1 '2300 Virginia Avenue,Fort Pierce FL 34982 unty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resiena
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDIMPROVEMENTLOCATION:
Address: l C)UU S ?UCS n> l G
Legal Description: Vd 1L4 J e L Ju L-
Property Tax ID#:- '45) CZAJ,",l ' wo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ;
�c'Pc.I t,C &/,ti �,(?-SM SUN Sl5!6'4 !�.v S 2 INCA �.
CONSTRUCTION INFORMATION:
AdLdaltJoijal work to MGas
orme un er t is permit-c ec a appy:
Lj`H'VAC �Gas Pi Tank g Shutters Windows/Doors
Pin I�l
11 Electric ❑Plumbing Sprinklers ElGenerator E] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ ``I?UC) Utilities: _Sewer[]Septic Building Height:
OWNER/LESSEE: ' CONTRACTOR:
Name Name: !Z0Aka L�14
Address: GO 30 S W q T(f S j Company: CuL4 =m,=JL1 /I/E. bvc
City: Miami State: . C� Address: 1pz 3 3 NotZI z oA/ 1A)
Zip Code: 33 f v - Fax: / City: �'f u��' Sr LcJc c - State:
Phone No. !IDG 2'Z61 39f3o Zip Code: 3H'9&0 Fax: X,
E-Mail: Phone No. 17179 v71(1/ 3TISLf
Fill in fee simple Title Holder on next page(if different E-Mail: 9ll0L14Ch?21'Zv(.3 0 a 0-4,11-
from
AILfrom the Owner listed above) State or County License: CA Cd,4 1 LS
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 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.
_ N �
Sig e O er Lessee ractor as Agent for Signat a of Contractor/Lice older LL�
STATE OF FLORIDA � �� � STATE OF FLORID12k,
COUNTY OF �N COUNTY OF
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a�i�n �Q 2
a.
The f rgoing inst ent was acknowledged before e=� z The f oing instr ent was acknowledged before e�>-
this day of 20 by �W this day of 20� by
Name of per cc
makin statement -;N•
Name of person�aking statement m p r makingstatement T.•
Personally Known // OR Produced Identificati n,,.,� 'v. Personally Known OR Produced Identificati
Type of Identification Type of Identification
Produced Produced
f�
(Signatur(iof tary Public-State of F orida) V (Signature of N ry Public-State of Flori a)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17