HomeMy WebLinkAboutBuilding Permit Application 09/27/2018 05 :48 AM PDT TO: 17724621578 FROM:5617631006 Page: 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �/ f
Date: 9/. ---.7/k g Permit Number: ` gag- 11 o 0
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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: 16 q( 0 4f\ar\e 5-- ltd4 {\A)0,Y ,f
Legal Description: .c 2V-Q Piciof\A\ c 011 phase I - 1 a1 `73
Property Tax ID#: 'JX ( 'W '"001i3 -COO 7 - Lot No. Zj 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: •
Additional work to be eriormed under this permit-check all(hat!apply:
CIIHVAC IIGas Tank Gas Piping !-1 Shutters Windows/Doors
_Electric 0 Plumbing Sprinklers ri Generator ►' I Roof Roof pitch
Total Sq. Ft of Construction: Sc\ Ft.of First Floor:
Cost of Construction:$ 110 SO Utilities: !Sewer _Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name 1s)O\,'A 7 ��`ES Name: S jVIRIV S TOLi cti0 t/'
Address: 769 I dr\0, \\e,crt lu \JJ 'J Company: ..s..&ROE,LI ', ) C
City: e"2- S; J—(,k-c. State: 5L Address: GI \U\iJ '0c'....c).} t( R ve
-.)).1"1"-)i
Zip Code: k; ! Fax: City: V'.��\ S i W1/4,--;\:. State:
Phone No. i Zip Code: 3 i'-( . Fax:
E-Mail: Phone No. -779.--177-DC'I V
Fill in fee simple Title Holder on next page(if different E-Mail: '-QOE f-1\NC(c) c( L 0_ c o fit+
from the Owner listed above) State or County License: C ii-tact Csci
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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09/27/2018 05 :27 AM PDT TO: 17724621578 FROM:5617631006 Page: 2
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 wor. a recording your Notice of Commencement. .
Signature of 0 ner/Lessee/Contractor as Agent for Owner I Signature of Contract. /License Holder
1 .
STATE OF FLORIDA ( '/ / ' i STATE OF FLORIDAJ•71 ju ce,e
COUNTY OF 4 z w ci t 1 COUNTY OF
• The forgoing instrument was acknowledged-before me The for instryment was ac,Xnowledgedri9efore me
this h day of_... ?f- (e4-1{2,e,20 I .t by , thisday of .,_ ef-ie.co m.<,20/45 by
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4.`fai1 _---- Ito/3'q 1 D.7,../ ,C77itqki ,-.5./6.. P-77--
Name of perso_n,laking statement Name of person Taking statement.
Personally Known L"- OR Produced Identification Personally Known 4.-/-OR Produced Identification
Type of ldentificati9w Type of Identification
Produced / Produced
. ,
_
---7-402111 , AserAiff ,
(Sig6,ture-of Notary Pu )Erik Nemoga slic-Af‘f Florida (Sig . .y.reof Notary Publi_-NI,'.;/4: Florida)
Florida..., ,. : si4 . =a Commission P G6101442
r ,4', t CmOion i GG101442 . . • t--, Do.r.
Commission No. _,: TzTi, .x.7:- Wiles:May 4,2021 Commission No. ii.7:,..,-.11`,.• Z• flotral:May 4,2021
Bonded thm Aaron Notary
'....Vtivo:•'„' Bonded thru Aaron Notary 40inn0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 •
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