HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` L{
Date: �q"� y Permit Number:
• RECEIVED
Building Permit Application Nov 9 2018
Planning and Development Services
Building and Code Regulation Division t Permitting
2300 Virginia Avenue,Fort Pierce FL 34982 S7. Lucie Cou Y.
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi ential
PERMIT APPLICATION FOR: Mechanical A f yam'
PROPOSED IMPROVEMENT LOCATION:
Address: `�G0
Legal Description: U0\CW0_ cocc&uj_s RLL (_0 -
Property Tax ID#: (-90 d S-) d ^000— 0 Lot No. 17
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:,7,
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LZK�10e)k L-k -CAAJ k_�L_ kk&k-
CON_ STRUCTION INFORMATION:
Additional work to e e orme under this permit—check a appy.
HVAC Gas Tank OGas Piping _fn Shutters Q Windows/Doors
0 Electric 0 Plumbing ❑Sprinklers 0 Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ ��U CU Utilities: _Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name �(`c`QS '�Vlo^m.O�S ftAName: JGSO>J
Address: 3�t 0`7 lam— `t-- Company: C_ \U0VU_ Mc cd \k-QG-k SO 1t, C-W
City: (--A- Y% u-(_k State: Address: % ,'10 NL SRO AUC
Zip Code: 34CO O Fax: City: CAP%OX-c-e State:
Phone No. Zip Code: 91Aq a, Fax: �7a l4at-S1N3
E-Mail: Phone No. P70__)-- -ILA LOA—S 12
Fill in fee simple Title Holder on next page(if different E-Mail: & 004' C01KA
from the Owner listed above) State or County License: '11�C_Ivy I LQ S r Q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
1
SUPPLEMENTAL CONSTRUCTION.,LIEN LAW..INFORMATIO.N:
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.
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 ay result in your paying twice for
improvement to your property.A Notice of Commencement must b re orded and posted on the jobsite
before the. Irs inspecti . If yo end to obtain financing, consul wit lender or an attorney before
commer)C I ork or r c r ' our Notice of Commencement.
Signa of Owner/Lessee/Contractor as Agent for Owner Sig aat a of Contractor/License Holder
ST TE OF FLORIDA ST, E OF FLORIDA
C UNTY UNTY OF Sk, Ly e N'Z
The forgoing instrum nt was acknowledged before me The forgoing instrum!�ent as acknowled a before me
thisa� day of*�t� 20,1�by this��day of N� 20 l by
CSq Sb v-. 46"� ( Oy S R, 'b Y�
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 Produced �L- e
(Signature of Notary Pu lic-State of Florida) (Signature of Not _�S
`'� --`•� DEAMARIEGIYEPIS
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A2fE GlurPl's, �' +tiffs" ':
"""' whi yM; Commission No. OMMISSI022023
Commission No. �— DEQ
Y COMMIS'tON#GG 022(123 ;oma, S December 1�,2020
=*� ki EXPIRES:December 16,2020 =; op,,,
%F•••;off= Bonded ThN Notary Public Undenwrlters
oµ�N Bonded ThN Notary Pubfk Und9.nv�ters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17