HomeMy WebLinkAboutBuilding Permit Application 'All APPLICABLE-INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: + Permit Number: ()no
RECEIVED
Building Permit Applicatio DEC 0 3 20'18
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 INPR01lEMENT LaCATICi�'
Address C r AVL ,q /2- l C- 3q9eL
Legal Description:
Property Tax ID#: � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D�TA!!LED DE�SGRIP lON OF WORK:
/Ze P rr A-C` 2 %--,1 eJ 1Y SC— c:-L2 GO o 512-W jl P-
e:-
�2
%�� C� f�/J rte S� R, UAJ IS jl 1k
CONSTRUCTION l'NFORMATION:
itiona wor to bepertormed under this permit-check all that appy:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ T DP) Utilities: —Sewer —Septic Building Height:
0 NERjLE�S� CENTRA TOR:
Name p�o I7d �� �r�G� Name: �/ ThAt)/4.eL r r��fl
Address: ��a C1 C r 4_a_ JS /� �c Company: M C-'i Q " C a Ik ` ,
City: f22 d-1- _ 77 e T C-t2 C M State:_(. Address: ,;�3 4 4 ,Ld iro I f
Zip Code: 2 Fax: City: S State:
Phone No. ?�2 Zip Code: Fax:
E-Mail: Phone No 2 361322o ,
Fill in fee simple Title Holder on next page(if different E-Mail M Ems'N &v J a 11 oo°C 0'"�
from the Owner listed above) State or County License /• O 6
If value of.construction is 2500 or more,a RECORDED Notice of Commencement is required.
t
SUPPLEIV�ENT AL CO�ISTRUCTION�3LEN LAW INFOf2MATIOIV
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 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.
1AIMA-4AI?
I—k 4
S a re of er a e/Contractor as Agent for Owner gna bre of ntractor/ cense Holder
STATE OF FLORIDA STATE OF FLORIDA _
COUNTYOF_ �� �(/C/C COUNTY OF :5T 4—C/e_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this"day of j6g.��.0 6�20 /v by this day of SCPT�M� 20JE by
/JJ
Itde_ll "44','�_ IVA 7-,%Il'01 E 1
Name of person making atement Name of person making statement
Personally Known�—OR Produced Identification Personally Known_ � OR Produced Identification
Type of Identification Type of Identification
Produced Produced
ZALEZ(Signatur of N o on a ( e o t idaSli�ZAf`
I ON FF245M :+= My COMMISSION FIF24S06A
Commission No cXPIR.,f;.• J"J)2019 Commission No .. July�ai�Ot9
=31M4153 FkrW&NaWfSerfte.em A"
163
_ REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
C