HomeMy WebLinkAboutBuilding Permit Application •
' ,
y` All APPLICABLE INFO MUST BE COMPLETED�/ FOR APPLICATION TO BE ACCEPTED II
Date: A ( vl 0 Permit Number: 1 gf 0— 0 c5g;\
,_ . i - _ RECEIVED
Cc) 7-
cam•
____-_-_ __,___I___�)__ _� `a-T Building Permit Application OCT 2 5 2018
Planning and Development Services Permitting Department
Building•and Code Regulation Division St. Lucie C nty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: 772 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
1 r r
R t r ,l_...-‘.:.,..1::::`40...." T � 4 , f °
+'f f � it:a k r5 tA��f L.• ..-- f. , ..,..:.',..1.-„;...;• .1y... i.. � :.. sw :'•:.4::
a. ...s.w.....�....
Address: 4g T1 3• mit�n.,(1 lK x.1)QI
Legal Description:.3� 3S-9D arrN se ccrnSLI C c4-- ayik Er C. .-
i
fin t• n � ,3 Q�o .LN ' t� E 1I ) -kc Li -�reb H-c , . .
Property Tax ID#::7 As -Z„ ^(M7.- C Lot No.
Site Plan Name: C)J /+ vs Block No.
Project Name: Do P
Setbacks Front Back: Right Side: Left Side:
r i 'T T
e •:1;:f, k.:-r :r1-1tq i :- i i t.Ix t } r ';.s i ti i- eitiy; I
1: � ' Gln,t'e--e \(f
1(( J1 ( f 0v2ii i1 I!1(1
' -' .,r : ,-4-.Y,-1; ft IC. ) l., r s,' 1iV3 ?_ _ ... - w : _3: _ v,S -.•
' •.itlona wor to se peorme• un•ert ispermit-c ec! a t atapp y:+ y � I!
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors j,
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ -S-) it)-) Utilities: _Sewer _Septic Building Height:
'tra g •.` Te • r` tt- Edi .! *,mc 6 3 :
Name ww\g, B re(4;. Q (Dey9 Name: . - ( it
Address: __v, if . S'. 1 . 00 Company: , +Oto(\ eklA4_I CSS C O.
City: _ 10 it .1) State: Address ( S 1- 11�n P�,l .�( p---
ZipCode: p-7 Fax: Cit : •-l'k0 State: V_
Phone No. S‘-= r Zip Code:a ` Fax:
E-Mail: 'tOerd` Phone No a'42- 65-4-130 9
Fill in fee simple Title Holder on next pide(if different E-Mail,�s�9,A c\ Vvo!-k LQ Co
from the Owner listed above) State or County License ftl 0.
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
1
i
Y"
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 w•rk or recording your Notice of Commencement.
tia.----> 1 / .4.411
Signa i re of•wner/Lessee/Contractor as Agent for Owner Signature of Contra-or/License Holder
STATE OF FLORIDA - N : STATE OF FLORI J o 0
COUNTY OF • ( vj� • ' P�. ; COUNTY OF C • l A x Q ¢-N
The forgoing instr t was acknowledged before m;. I z 3 The forgoing instrument yeas acknowledged-before m m Ia
this�S day of L�r " ,20 J by m gg i this,Zday of U c.,-t-- ,20 2Sby 1 sW 2 •
EN ( ¢O.¢ 2
¢miz . 53xo
=oar- >Wg
;;�'�lA�� L �`?"�z < all .Z �'J .
(Name of person acknowledging) s m (Name of person acknowledging) ,0::.1.ik; '
014 A.L. j ;. a., t�` /"�/LQ� ( , 74 ��
ar
(Signature of Nor ,Public-State of Florida) V • (Signature of Notary blic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification .
•
Produced Produced
Commission No. (Seal) Commission No. (Seal)
•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE •
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE •
COMPLETED
ley. 7/2014 .