HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Lpprtmnent
Date: i t ( 2d1 Permit E®Building Permit Applicat2018
Planning and Development Services
Building and Code Regulation Division �
2300 Virginia Avenue,Fort Pierce FL 34982 U�1 E FLPhone:(772)462-1553 Fax:(772)462-1578 CommercialYr
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMLPIZOVEMENTLOCATION:'
Address: (, -799 DICA�I1uSc)AI 2
Legal Description: L_ 'i- X N O 0P- LN 2,S (, A-i 1; L
Z2 L A-C 0 a 7�, LLet k �-�-�
Property Tax ID#: S_- -706 - 000 - 000
!9 1-14Lot No. f S3
Site Plan Name: O L P-A_w IJ �_g Block No.
Project Name: - �e�lc � /JV 3-- L, L
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: • ';
I.ISTALL` F-2-3 /UCC 3o/>C^ \�/ AL,v,.J` E !r5 i � i t� z o �.., i-IvvSe
^us'T f�NS �fl C f�2o�z �► u 1t- �� 15�c 3 � J ups% ��'J� o� ;t�
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CONSTRUCTION INFORMATION...
Additional work to (eperformedunder tispermit-c ec a appy:
HVAC L 1 Gas Tank Gas Pi _ Windows
/Doors
Piping Shutters Doors❑ /
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: �- S . Ft.of First Floor:
Cost of Construction:$ `�5 O c7 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name__ o5c�l„� W �J t Co�`T �T Name:
Address:. fo`19 `1 Z!�kcKNSZ)tJ f 2 Company:
City: DST S-\-. L oclt: State:)�:L- Address:
Zip Code: Fax: City: State:
}
Phone No. �65L 3,q 1 Z0 D Zip Code: Fax:
E-Mail: W Q � L 9 L,'T N :� 1144 4_ , Co/0 Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above). State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION. '
DESIGNER/ENGINE _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: N Name: tV
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Appiicable BONDING COMPANY: Not Applicable
Name: oz,L,, Name: /y ✓
Address: c, ,z q cc C[N J eNJ Address:
City: T6 2T' S/kt^FT 1--,i C f City:
Zip: 3 co,., -1 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 work or recording our Notice of Commencement.
Signature of 0 ner/Lessee/Cqh ractor as Agent r nom` Signature of Contractor/License Holder
STATE OF FLORIRA_ i M� STATE OF FLORIDA
COUNTY OF l ' (— Z- :,<-<
COUNTY OF
The forgoing instrument was acknowledged mbefo �gS2 Pa The forgoing instrument was acknowledged before me
this�day of IN `� 20 l,�by z this day of ,20— by
O ae
,y A
Nae of person makin tement `ON Name of person making statement
Personally n OR Produced Identific 'N Personally Known OR Produced Identification
Type of Identifica ' nType of Identification
Produced 1.06— _ t , Produced
(Signature of Nott;
ot Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17