HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:In.as •(g Permit Number: 2 in
RECEIVED
Building Permit Application
Planning and Development services O C T 2 3 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County, Ferfbitting
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 LOCATI N
Address: fl 41, W'
Legal Description: i � `
! gy C L L
Q �.
Property Tax ID#: 3LI10- 311 - D00a- dao - 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
-�rNS41411_1uS (3) F-AN5 , IP1 'Setu"Cc 061-J-kk-
CONSTRUCTION INFORMATION:
Additional work to fl
orme un er t is permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
�lectric 0 Plumbing Sprinklers I Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:.$-. RSdO. Utilities:�Sewer Septic Building Height:
OWNER/LESSEE: 'CONTRACTOR:
Name Q aA iuo QLC4, 1,L4C- Name: UESus �o SEN EZ
Address: �5d0 NUCk-b6e- 3! /UJ Company: 61GC-&f_ S�Iw+'cE
City: SSRI- ftlM �IWL State: f( Address: /333 su 99V4 Aue
Zip Code:
193411 ,/Fax: City: /Al.1 A,- State: FI
Phone No. / �oZ 7 Zip Code: 3331?6 Fax:
E-Mail: Phone No. 3o5 - 2S(o- g77 3
Fill in fee simple Title Holder on next page(if different E-Mail:_f aL f N0
from the Owner listed above) State or County License: i /�60 3Sp
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN-LAW,IN.FORMATION
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 inspectio . If you inte btain financing, consult with lender or an attorney before
commencin work rec o ice o mencement.
Signature of Owner/L ee/ ontract or Ow Sign t re f Contracto a Holder
STATE OF FLOF FLORA
COUNTY OFORIDA n COUNTY OF M!Dm= !` Je
The f oing instr en was acknowledge efore me The for oing instrument was acknowledged before me
this day of 20Aby this day of (��+ y� — ,20 by
Name of perso making statement Name of person making statement
Personally Known OR Produced Identification Personally Known_4�2 OR Produced Identification
Type of Identification Type of Identification
Produced Produced
BRIANNAE.CANGEY
:.[ W COMIfMISS1ON 11 CrtG 139;Toa
Lim M)
11. °b N - ur ary Public-State of Florida)
Commission No. (Seal) Commission No f��"1 OS ?o Y SeaLr,Public State ofri xi
Marcus Ford
My commission GG 188 49
gno' Expires 02/21/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17