HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: I I I®I Permit N
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Building Permit Applica on Nov 16 2018
Planningand Development opment Services
Building and Code Regulation Division Permitting
2300 Virginia Avenue,Fort Pierce FL 34982 S L /Depart ent
Phone: (772)462-1553 Fax: (772)462-1578 Commercial &Ia OU
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LQCATION' :, f
Address: 5361 ScJ()te,(N Cif r.Ae
Legal Description: '7�yC�,�;-iy1t, ShbT2g CPT34-�-16) LOT LIG-4
Property Tax ID#: 131 Z -501 •- O r)bb--`,3 Lot No. 4(p:-
Site Plan Name: Block No.
Project Name: .W I I SU M :j)2S4-rQ j-
Setbacks Front Back: Right Side: Left Side:
DEl'AILED DESCRIPTION QF WORK '
A) K Gv / >n
CONSTRUCTION 1NFORMATION =
x.
i lona wor to e e orme un er t is permit c ec a u appy:"
Add
L Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers I Generator F] Roof _ Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ �J S®� Utilities:i Sewer Septic Building Height:
OWNER/LESSEE CONTRACl"OR.
Name cet_yn iso `���trai- Name:_�YWX]S(,0 5012
Address: 5261 5iint)6g�/V Cir-, Company: d- 1 ncA
City: fiats �a�c ems- State:T-L. Address: �`�3 8Ifii in Ace-
Zip Code: 3IaSC Fax: City: Mtckm. State: T:�,
Phone No. 79L R 3-2-S Zip Code: 111MO SVL'Iy Fax:
E-Mail: Phone No._C� �3C� 31S - 110(4
Fill in fee simple Title Holder on next page(if different E-Mail: Q ual i Incl i ro9 ayKe f 1 CLI(W%YAk,\•Co
from the Owner listed above) State or County License: CA.L'z IA
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
,SUPPLEMENTAL CONSTRUCTION U N�" 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.
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 record ink our Notice of Commencement.
Signature o Owner Lessee ontractor as gent for Owner Signature Mad"'actor/License&1der
STATE OF FLORIDA STATE OF FLORIDA n
COUNTY OF � COUNTY OF B)q LJ
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this Z day of 6tl"M-b-Cr 20 );9 by thiis�7 day of N0111)24W 20 A?by
kA
YrutcGt�GO �ia Z
Name of person making stat men Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced (r i G Produced J C
(Signature of Nota ublic-Sof Flon (Signat4oary Publi - to of F ri )
Commission No. eal) Commission No.a1.!55X'1 (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
g8onded
STEVEN LEVY
Notary Public•State of Florida ;o1►vr°iieG: STEVEN LEVY
EA 4 MORA 0
Commission ft GG 255569 '_: ^ Notary Public-State of Florida
through National Notary Assn. aF+ti.•` My Comm.Expires Sep 5,2022
Bonded through National Notary Assn.