HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O / -�� Permit Number: /go
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� iu/ �k},d, Y,-Buildin Permit A licAUG 2 8 2018Planning and Development Services tting DepartmentBuilding and Code Regulation Division UCIe Count
2300 Virginia Avenue,Fort Pierce FL 34982 �r �L
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: rW0
PROPOSED i0AbVEMENT LOCATION.
Address:lyse>71,--5. b/y j-e,?, fe i Otacy , fiz- 3Y575-;7
Legal Description: lVe 111,,1S 1,4.W .�T✓J�• �0�/7'Iy3�
Property Tax ID#: /502 - -TO/ - 0,331 000--0 Lot No.
Site Plan Name: )76//'Its Block No.
Project Name: /75
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF WCtRK
,V e Dh`A-ew 0 1 0� �/0, a�� e h ate,P OA" .
CONSTRUCTiONINFORMATION Y _
Additional:wor to be per orme� un Bert is permit-check all that appy:,
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 1:00
Cost of Construction: $ /900.06 Utilities: Sewer _Septic Building Height: �r
01lNER/,LESSEE CONTRACTOR; G
Name 1-w0 Id Name. Si�ffti
Address: -77ol _er F,-Ie k1A,_ Company: am Skaf Sye•
City: (::n%h C,,,7 Y?a 7-i State:0j/ Address: ddl ✓yzf• ,S�L-
Zip Code: yT.�`l 7 Fax: City: J7 Oye, gea'-4 State: �G
Phone No. 8/3 -789- 969 Zip Code: 3,1,75-7 Fax: 77-2 X3.2
E-Mail: Phone No 772- dO - Y7/T
Fill in fee simple Title Holder on next page(if different E-Mail Q cC!n, S�� � i G 140 0• c on
from the Owner listed above) State or County License 4, /,Z 5/48
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW.INF.ORMATIC)N ,
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 worLol fpcordingate tice of Commencement.
Signature of Owner/Lessee/Contractor as Age r Signature Contractor/License Holder
STATE OF FLORIDA o STATE OF FLORIDA
COUNTY OF COUNTY OF P"
The forgoing instru nt was acknowledged be rm ac
The for oing instru ent was acknowledged befor vo
this day of 20a b 2 mK x this day of 20 by oMM
mom„`�.cn _ w
15 MR=
(Name of person acknowledging) 8- (Name of person acknowledging)
(DN �N
(Signature of ry Public-State of Flori a U (Signature of Nota Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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
ev. /2014