HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I
RECEIVED
Building Permit Application NOV 2 7 2018
Planning and Development Services
Building and Code Regulation Division _ ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line <Car
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Address:
Legal Description: (�utznS Ccy,Z ' un l-�
Property Tax ID#: JY2 3 _ Cp0 2 " ODS O - M , I Lot No. /0
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILEDDESCRIPlON , q��
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Additional work toe e orme under this permit—check a appy:
HVAC E]Gas Tank ❑Gas Piping OShutters n Windows/Doors
L1
11 Electric Plumbing Sprinklers Generator _Roof / Roof pitch
Total Sq.Ft of Construction: 'P704 S . Ft.of First Floor: Ll-70
Cost of Construction:$ �9 3 5 — Utilities:11 Sewer Septic Building Height:,
Name d ffikl e— Name: Gt 2 dul''/L e
Address: 105 S 20 R Company: > Ja
Name- 71;kipDffnae�f-
City: 1«(c,Lf'0h(AS0/1 _Q714A 0( Stater Address:. DJJL/ 5W 4'a S+._ Aaae.
Zip Code: 3Y q y Fax:_T�A— City: u oIl d W m d State: 'F-L_
Phone N42/7)77Z•5UP Z Zip Code: X33)2_ Fax:fvl
E-Mail: 13(L_IYSA'3 I1 C!o-4. T- Phone No. Siff a - 4y/5
Fill in fee simple Title Holder on next page(if different E-Mail: (JefK. L
from the Owner listed above) State or County License: CCM
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LA�MINFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COM ANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phon
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Pho 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
comrRencing work or recording our Notice of Commencement.
,#-,, ZL'f � ((N&
7Si ature of Owner/Lessee/Contractor as Agent for Owner Signatu Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA.
COUNTY OF Sir COUNTY'OF '51L Wct-Q
The for oing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this day of ti0 V' 20Lby this j'day of /W-,'v 20_�'by
4egVL AohvN C. . R.nnes inlaur►e_ Qwme,4
Name of 4erson making statement Na of erson making statement
Personally Known OR Produced IdentificationsonaIIy Know OR Produced Identification
Type of Identification yp entification
Produced trsypop, MANUELHERNANDEZ Produced
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�* CMY 0 IMM SSION#GG 004918
EXPIRES:June M S 0
N9jFOF Bonded ThN Budget Nototary eMCeS
(Signature of Notary Public-State of Florida) (S re of Not -
•:c�;Y?ue�,� LAU EN BIRKINS
Commission No. 4a-6 ooY9/f( (Seal) Commission Ni . 's. . :°i Notary RsWWState of Florida
O� Commission#GG 071722
of: } Mv Comm. Ex ires June 9 202
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17