HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a �� Permit Number:
RECEIVED
Building Permit Application SEP 12 201.8
Planning and Development Services
Building and Code Regulation Division S'f. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential�C —
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ( o -en aH
Legal Description: Uh (C-i q CJD Ob &e LID 5 L 5a Ea- QP- M IQ ''t- aE(A{-(off L`S6
Vap- ail L A- 0�11 M- u_0Fr+- op- Ldp 69
PropertyTaxlD#: 311.03— 5oa-blas-t0Q-1 Lot No. kAt
Site Plan Name: nn Block No.
Project Name: 916
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
l Fc( . LCA qqct ( a4` room
CONSTRPETION INFORMATION:
AdLditigAl work to be nertormed under this permit-check all tha appy:
L_JnVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
0 Electric El Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: ^3 5 L1®` r c-R_ Sq. Ft.of First Floor:
Cost of Construction:$ ri `!� Utilities: Sewer El Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name at^n Name:�5C'0 f4- �l ,
Address: 5e-[\ , Company: 4z 1 eZ O�.�-cam LLC-
City: (- f_�rC� State:�L- Address: M6 Sq Ell- o�Je—
Zip Code: Fax: City: \&M (3>ec1_f_-k State:,
Phone No. 0 Zip Code:SSM (e-O Fax:
E-Mail: /1f�k Phone No. ?'0L Z(3'Q(I$_S
Fill in fee simple Title Holder on next page(if different E-Mail: Sc��-I' ® ('P��(7�2J,��010f-�CUy✓l
from the Owner listed above) State or County License: galo r 33
Cu'v r°"
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 po Is,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Yoyf failure to Record a Notice of Commencement may result in your paying twice for
improvements to your Kording
perty.A Notice of Commencement must be reco nd posted on the jobsite
before the rst inspectIf you intend to obtain financing,cons ender o an attorney before
comme ci wor or our Notice of Commenceme
Sig t ire of Own / ssee/Contractor as Agent for Owner Signature of Co nse Holder
ATE OF FLRIDA STATE OFF ID
COUNTY OF�ti`IfllQ �1rW COUNTY OF �c1�vy
The fo��.gg�oing instr en as acknowledged before me The forgoing instrume was acknowledged before me
this I(`I"day of t b .f .0'? by this--I day of20��by
Name of person making statement Name of person making statement v
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide tca ' Type of Iden ification
Produced Produced
(Signature Notary { �f&DT-F(°` Ia ign ure of Notary Pub' - to of NOTARY PUBLIC
=�E.,, REBECC A.TEMPLE oQ
Commission Ni . '�; aA�oa"`_ QP
Notary Ppeajtate of Florida Commission No. �"' o ''TATE OF FLORI
Commi Sion-GG 177509 ,r W omm#FF210440
My Comm.Expires Jan 24.2022 F Fal D `t"4� s�NCE 19►� Expires 4/4/201
Bonded troagn Na:ionai No:aryAssn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17