HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:1Z[2,_-_C fl
RECEIVED
Building Permit Application
Planning and Development Services DEC 0 7 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 T. Lucie Co y, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ReSI
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
l
l 1 �L�
Legal Description: l-bbl l d 1 - Peel- S 5 16-1144e
Property Tax ID#: �y�U "t/�� y�/�'ok"O'3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE'SCR[PTION OF WORK:
4C W n eleod
'CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC Ei Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric El Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S °``�'' S . Ft.of First Floor:
Cost of Construction:$ �'I (J G1 Utilities:-Sewer E]Septic Building Height:
OW N ERAESSEE: CONTRACTOR:
Name Name:
Address:_ I �Y,el N.MA 15V7tY71b1,1 � Or- Company: 2a P A�/%E/foz-1id-
City:� ��a6�Y• State:�� Address: I/ Gi�,IJ ��!J �—�()A 1l
J77
Zip Code: J� � Fax: 1\14' City: ZJ a►r fi State: z
Phone No. %-�,� ✓i � 7 Zip Code: "7 If Fax: -��� ,_(o2D
E-Mail: b�EQ Ay cz)/"? Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: &Y 6 Qi'JC_(0_1,4II Flf)6,611A . L-01-Y1
from the Owner listed above) State or County License: l
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
,SUPPLEMENTIALZONSTRUCTION LIEN LAW INFORMATIOIU
�.
DESIGNER/ENGINEER: - _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: 04 n yav/� Name:
Address: ?,Cry 7�i/%��v�?� Address:
City: s State:=V City: State:
Zip: Phone 2- — iG 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 recoilding your Notice of Commencement.
a'/';v-
Signature of Owner/Lessee Contractor as Agent for Owner Signature of Con actor/License Holder
STATE OF FLORIDAdarl-in
STATE OF COUNTY OFORIDACOUNTY OF / .
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this ay of 20 7 by this ►u,bay of �tGt vYil�[f,20_LZ by
0688_r AW 660 /U._�2 R0_1,Z0r7_
Name of perso making statement Name of person making statement
Personally Known OR Produced Identification Personally Known _OR Produced Identification
Type of Identification Type of Identification
Produced Jrced ,.n'+rr, Notary Public State of Florida
�s eta Notary Public State of Flo ida c Veronica C Arteaga
^� Veronica C Arteaga _ 6 My Commission GG 057227
My Commission GG 0572 27 y'k rer• °� Expires 12!21/2020
Expires 19191/2020 0A
(Signature of Notary Publ e-SStaYe:,^I:lr mV&) ture of Notary Public-State of Florida)
Commission -7.57
(Seal) Commission No. 0J5 AI- (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED ,1
Rev.8/2/17