HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I'"
Date: aQ' /$ Permit Number: l S ! I 0 3 x&
im.._: �.s^ ._-...,,-1 RECEIVED
COUNTY ti Nov E...4.,DAl b A IVO Y � ®
witammogimmiff Building Permit Application 2018
Planning:and Development Services. Permitting 9epartment
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential 1/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: " . , _
Address: .24;73S. Abu Se4 r& $ cbr• tk ( ;41-yFL 3V59D
Legal Description: Qr.,l atnr' 02.c f e P1A- 0 F fr t✓l� e ' /S
�{ ,� 7` ! otr y (Ali i� G(r.;t
Property Tax ID#: YV4P6 - eOcc - ODfS ® 0610 Lot No. 1
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESC.RIPTION.OF WORK:. Q
)0t.t t It X-7 (!"fir 2)00 r ( Like -A /r (�k e) /I
i'l r .1 10,de 01P
CONSTRUCTION INFORMATION:
Additional work to erf
be ormed under this permit-check all char apply: "
HVAC Gas Tank nGas Piping _Shutters Windows/Doors
11 Electric ❑Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 23Q0 vn Utilities: Sewer El Septic Building Height:
,OWNER/LESSEE: :CONTRACTOR: -
Name .0 epi AO'
Ai;'‘ Name: %l /L to foe Z/�
Address:0,; 5. /O'DSe' v '1S Company: S C/+®ice [i-wz , a 2) dor.r
City: rich- kn. e.4-y State:FL Address: 183-i 7 5.14/ el r/1r it;h 4t '.
Zip Code:3y9 D Fax: City: 1-SL State: FL
Phone No. 33 6 l 8'YS Zip Code: 3 yfs3 Fax:
E-Mail: - Phone No.( 7 ) 370- / fb ,
Fill in fee simple Title Holder on next page(if different E-Mail: N Sep•r 14,17 Qe,�ar�. eh-%
from the Owner listed above) State or County License: 42 ejt-sy3.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
{ i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION f ;,
s
_Not Applicable MORTGAGE COMPANY: _Not Applicable 4
DESIGNER/ENGINEER:
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
commencin• work or recordin•your Notice of Commencement.
AK.
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Signa e of 0 er/Lessee/Contractor as Agent for Owner Signatu of Contractor/License Holder
STATE OF TATE OF FLORIDA
COUNTY OF FLORIDA..3'r'" Lu Ch C_ COUNTY OF Sr LACI -e
The forgoing instrument w s acknowledged before me The forgoing instrument wa acknowledged before me
this IP day of N ov ,20_18by this aoday of n9 ,2O_, By
Son Ni L yn n Lome z 4 C\ Lynam Lo�2 z:-
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 'p LSA.— Produced ) L. F L
�d1�l ilk! ht- .6„........- ��
Si nat "` SPubl�e� d9 (Signatur: Ifo` P blicEfa•- ,.4' r ,7 a "
s• u� o- tate of on a-Notary ublic _;;,� *- tate of Florida-Notary Public `
*1��•= Commission # GG 2�7 079 = - Commission #GG I
Commis .',` 'r1ii►a: E �._ _'P;
p� � Commissi��N"s 1 i!‘°,� M �.4�I�g
%;OFilss Y Commission �51 S ,imi�i�, y COrn}ni9310n Expir
es" " ®pteber 22, 2022 October 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE l
COMPLETED ,
Rev.8/2/17
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