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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE/NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 12 /g Permit Number: �•©©� RECEIVED DEC 0 3 2018 Building Permit Application Planning and Development Services ST. Lucie County, Permitting Building and Code Regulation Division > 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROPOSED INPROnVEMENT LOCATI©N: Address: Legal Description: et"—,_r kik e5Va+__,SCXR 1� I 1. o•��I FTQ Property Tax ID#: 1-/3b- -5, %102( - 0 60 - , Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DE�SCRI�PT ON OF WO �K: e, G i^, pejC, 1-j( v CONSTRIJCT)ON INFOg.RMATI©N: itional work to be pertormed under this perm-it---check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing( _Sprinklers _Generator _Roof -12— Z Pitch - Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ y 7, D Utilities: —Sewer _Septic Building Height: 011114 @1 CONTRA OR: Name Name: Address: OZ 5- 41 Company: P`' City: Fgzi State: lc& Address: Zip Code: .3'Y461 Fax: City:^ State: Phone No. X72—off 0(- 1/ 4 9 I Zip Code: Fax: E-Mail: J_ «�e-I rt2,/(,gD)goIW�oM 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. S:UPP:LEMENTA l C. ,I,�STRUCTI:0N, LIEN LAW f,N.F i RIVIATIO;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 thepermit 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 improve rents 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 Ow er/L s ee/ ontracto_r as Agent f&-r-Own eF Signature of ractor/Lice older STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S�- /L,(L('-1.r� COUNTYOF c LU C;1I!. The for oing instru ent was acknowledged efore me The for ing instr Hent was acknowledged before me this/�day of OV 20 /?by this Wday of 20J8 by DIWM& A±Eaf UlomPI &rU+7_,. Name-of person making statement Name of perso aking statement Personally Known OR Produced Identification Personally Known I/OR Produced Identification Type of-identification Type of Identification — Produced Produced 2 tc". ti (Signature of NotaryPu ' -State of Florida) (Signature of Notary P blit-State of Florida) Commission No. ROSA EL(S>fIJH PLEITEZ Commission No. ?r "• Notary Public State of Florida :1yv v�B:. OSA ELIZAB H P ITEZ u •.. % yr X Commission#GG 249666 ;_°; ti��=, Notary Public State of Florida 'f My Comm.Expires Aug 16,2022 'a- Commission#GG 249666 Bon ed through Nation Notary Assn. ori;: y o REVIEWS F I OR PLANS VEGE Bo d r i al ota Assn. OVE COUNTER REVIEW REVIEW REVIEW REVI W REVIEW REVIEW DATE RECEIVED 'DATE COMPLETED Rev.8/2/17 S;U;PPLEiMENTAL CONSTRUCTfON;LIEN rr,`W RIVIATIO,IV 7 - ` DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not'Applicable Name: Name: t 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 commencing work or recording our Notice of Commencement. Signature of Ow er/L s e% ortractoir as Agent for Owner--= Signature of ractor/Lice older STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 9- . kLtC_r e COUNTY OF ku(_1 e The for oing instru Went was acknowledged efore me The for ing instr went was acknowledged before me this day of /OV 20 /�by this day oft Dyft& 20]A by Name of perso making statement Name of perso aking statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification - Produced Produced (Signature of Notary PuW--State of Florida) (Signature of Notary P blit-State of Florida) Commission No. :'.,;:Pu'•. ROSA EL(SeaI H PLEIJ22 Commission No. x •'^'� �` Notary Public-State of :1y�r v�B., OSA ELIZAB HPL.ITEZ Ml: Commission k GG 249Notary Public State of Florida o My Comm.Expires Aug 1 =.y 'o Commission q GG 249666 Bon ed through Nation Notary or y mm.REVIEWS 'F OR PLANS VEGE Bo d r Val ota Assn. OVE COUNTER REVIEW REVIEW REVIEW REVI W REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17