HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / / Permit Nu
is align
OCT 292018
Building Permit Applicati
services permitting Department
Development Plann►ng.and 'St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)4624553 Fax: (772)462-1578 Commercial ReSideCltial V
PERMIT APPLICATION FOR:._ To Select from dropbox, click arrow at the end of line
PROPOSED r IMPROVEMENT LOCATION:
Address: 7�� ' e�W?OCI al2t d-2 e/XC
Legal Description: Z:)Gp e,9 ep/.p �411Qrd 1z1_z1AA /_=10/7 �5_ 1-07-113 /, 9 Zl9
Property Tax ID#: � 2 74a- D j' 7� 00 3. Lot No..
Site Plan Name: Block-No.
Project Name:
Setbacks Front Back: Right Side:, Left Side:
DETAILE 1-ib SCRIPTIONDI' WORK:
(7)
0) 6 m F s,-,oQ__- 620
CONSTRUCTION INFORMATION:
Additional wor.k to be ertormed under this permit—check a p y:
HVAC Gas TankGas Piping _Shutters Windows/Doors
Electric 0 Plumbing' 0Sprinklers Generator F� Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
m�
Cost of Construction:$ � 0; r Utilities: Sewer E]Septic Building Height:
O,UV=NER,/L€SSEE CONTRACTOR:
Name ���� �U2��YZ- Name: '4::GA w, �t�ee
Address G'. r o4eeM1� C�/1G,�� Company: . 'c<r Co,�s���vl•ttf`C+�'�'"
City: pele-i'.r t'ZU&lc State: - Address: 3? _s'ft�?7t �� 4W
.Zip Code:-!?Z/9e6 Fax: '
City:_40'09'r 4 T7luerr State:_4
Phone No. Zip Code: Fax: '7'7a
E-Mail: Phone No. -7.7-z _'2_0 1. —a t I
Fill in fee simple Title Holder on next page(if different E-Mail: ZA~ QZ e{4A I L, -C
from the Owner listed above) State or County License: 2JZf- Z
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW 1NFORMATION:
DESIGNER/ENGINEER.' '. Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: . Name:
Address: Address:
City: o State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE.TIT LE•-.HOLDER: .r 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 thepermit 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 d to obtain financing, consult with lender or an attorney
Y
commencing work or recordipg your Notice c SQnamancement.
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Signure of Owner/Less /Contractor as Agent for vMne"r Sigy0fure of Contractor/L ense Holder' m{
Hz s ��_
STATE OF FLORIDA :o o STATE OF FLORI — Z M
COUNTY OF Gti z M�M COUNTY OF
c �–
z �o= & 3
The forging instru nt was acknowledg�d,before The f r oing instrument was acknowledge of mei
this day of 20 by —H= this day of (°,f` 20 b
�1x • L-ee N Lee- 1 N
Name of personmaking statement Name of person making statement
Personally Known - OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Type of Identification '
Produced Produced
( ��
a
(Signature of No y Public-State of Floridw) (Signature of Not ry ublic-State of Florida)
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
Rev.8/2/17