HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (\�/
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Date: Permit Number: v
a3 RECEIVED
Building Permit Application SEP 17 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
PROPOSED IMPROVEMENT LOCATION:
Address: �yn�� �� cam!~ . i=L- Z�19S-1
Legal Description:?-,F a I� r t o ' S e c+, c-3r►t�
Property Tax ID#: (4 I ci Lot No. ) I
Site Plan Name: Block No.
Project Name: V-.-, :�,4-4, 1
Setbacks Front 1 Back:-a -Right Side: 5�_ Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy:
❑HVAC E]Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing []Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ - 9��.Co Utilities:Sewer[]Septic Building Height:
OWNER/LESSEE: : CONTRACTOR:
Name 6AA4^J e_F Name:UZ)au&-2"�haaxaS
Address: 2'x-1 1 SF ICompany:' br_,A&16e- i 4.�0,�ad�1104* GLOG,
City: State:V-L- Address: 46D44 SW 42,1,0 Q r
Zip Code: 3`I 9 q '1 Fax: City: e;tk o=- State
Phone No. <-uI - 3�3- 9'1'1 o Zip Code:315 12 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail U-LkkSP—rC Aa D CM AJ C_
from the Owner listed above) State or County License:C,CIC OtNl�liSC Otel�l2S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL,CONSTRUCTION LIEN,LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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
commenoinR work or recording our Notice of Commencement.
S
Signature of Owner/Lessee/Contractor as Agent for Owner Si e f C ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-I- LVc�iFCOUNTY OFFS'—.►-
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of_5EPT— 20 L18 by this (.A day of Seip 4-.,20 V?� by
P�.�wL Q Ti A tlN t:;-C I 1`bl e` WAYNETHOMAs BURN r
(Name of person nowle ng (Name of perso a In
(Signature of Notary Public-State of Florida) (SignFnn
blic- ate of Florida)
Personally Known OR Produced Identification Pers OR Produced Identification
Type of Identification Produced Typoduced
ypY PU Nota P c State of FloridaCommission No. oti acC (Seal)
Fran�s���Almeida
v My Commission GG 139459
MIGUEL A MERCADO;yo
Expires 08129/2021
L!2��GG09S74,9Revised 07/15/2014 2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS