HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / C/
Date: Permit Number: / r (5 V/0
ECEIVED
Building Permit ApplicationLCR
SEP 19 2018
Planning and Development Services ie
Building and Code Regulation DivisionPemW �9
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial _X_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �009 3 u_ ) H 6 W V
Legal Description:Si i +fit s 2l. 3(. 1{0 y3 2- Fr_�,q ,NT cF \.4 JW LX LXSI AND L_%O.
SEC PLUN Stay nL6 3D W ?4W L.1 SIC FT" TO FQO
Property Tax ID#: 3 q i L4 n i I ROS .3 1 O q Lot No.
Site Plan Name: N.Go-t)I, / C) Block No. 2-
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
��I� c e s h;n i�G c KG�,e ��► �.. irock w1 0 k w kirti fi�i .
i
1 S t,f , Li �e �o,` 1►Ke C[�6, eCOk -.
CONSTRUCTION INFORMATION:
Additional work to be Pertormed under this permit—check all appy:
LINJ HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers 11 Generator L]Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ��11$S , (� Utilities:oSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ' ( L + v Name:__��, ri S K l'2r"yl
Address: 15 Whk (y'An br. Company: (�� ti�LF / (
City: NC'ok-1 'I State:JN Address:3`J� SE 1.J1•; -,�rC 1�r . '
Zip Code: I I Z Fax: City:_?S L- Stater_
Phone No. 1,1 Q `{1-4 I - 5 0_7 LD Zip Code: 3`I C 9 Fax: b
E-Mail: Phone No. 1 L S 11 - I lay S
Fill in fee simple Title Holder on next page( if different E-Mail: Gly 6r J&_AP G C P xa<LGQ.IS 01 f OM
from the Owner listed above) State or County License: C It L.I C1 ID
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU ION 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: 7& 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
commencing work or recording our Notice of Commencement.
S
Signature of Owner/Lessee/Contrac gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAf STATE OF FLORIDA C
COUNTY OF �1 L LA c', COUNTY OF J Luk(-',c
The
-uk(-',-
The forggg9ing in strum t was acknowledged efore me The forgoing instrument was acknowledged ,fore me
ti L! of 20 by this day of KO r 20 by
V�nt�►•r S ICU 7�/tk f Z �,y�/�r� •J f�--tn 2�1.e �Z
(Name of person acknowledging) (Name of person acknowledging)
— k '�4 1./ L0. L--
(Signat re of Notary Public-State of Florida► (Signa re of Notary Public-State of Florida)
Personally KnownOR Produced Identification Personally Known OR Produced Identification
Type of Identificati nod
Pruced Type of Identification Produced
KAREN D.CHISH)L *Bonded
KAREN D.CHISH
Commission No. G I643S� :M MYCOMMISSION#F9W ssionNo. F 5`�3S(�iMYCOMMISSION#F 4356
EXPIRES:MAY 18, 020 EXPIRES:MAY 18,2'20
ROM thfaugh 191 Slat M.W.".. through 1 urance
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS