HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: la g a Permit Number: �a �2f
s.: RECEIVE®
Building Permit Applicatic n DEC 18 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. L CI County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
,PROP,O$ED IMPRO.vEMENT:LOCATION -`
Address: 3/ .3 &MaA4mof ypazj
Legal Description:3d 3-/30 X s4 W.�ys, 6 'r(oC ff,5Jk A) 14gr Rlh)
Property Tax ID#: Lot No.
Site Plan Name: 9" Block No.
Project Name: �r-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O`F WORK: -
640tv , to`, axt- .3 i 7a -�
CONSTRUCTION INFORMATION.
r Additional
work to be nertormed Gas Tank under t is permit-check a appy:
❑
[]Gas Piping _Shutters ❑Windows/Doors
_HVAC
Electric ❑ Plumbing []Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ .7�0'�� Utilities:nSewer[]Septic Building Height:
OV1lNER%LESSEE. CONTRACTOR:,
Name 4' Name:
Address:.3/70 A2 µm Company: i
H' d[
City State:. Address: QUYLS �. 9v 2 .
Zip Code:.1'?#J' Fax: City: P.c A4.C� I Stater
Phone No. Zip Code: .9-1/945 Fax: 7;ZR-5f6 !'!49
E-Mail: Phone No.2;W- q61- 0?77
Fill in fee simple Title Holder on next page(if different E-Mail:ry►;,�� Dn Vie-;Q ���h �a,L.. �-on7
from the Owner listed above) State or County License: ed
SLG 8 S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPCEII/IEFVT�L.�aNS�"�t�.1C�(ON l.1f=N LAUD! IN�t�RMATION €t .
�_5�-�=-�^' .�..,f:R*, __.,.iia. _�..,,.. c..,.��i,�.Mr.��`<<�. ...«r-,x:_�. .�.�_.,,• '*'__.�., �. ,.:w -z_t�� r,<;,..:ri �w',..+..,.�t,r,F 'i. is., ?�.'„��� "�e_i.mss..�-, .:�'��s
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _)L 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 postedon the jobsite
before the first inspectioV."ou intend to obtain financing, consult with lender ora ttor ey before
commencing work or reebrcliqk your Notice of Commencement.
c
SigWafLG of Owner/ see/Contractor as Agent for Owner Signature of Contractor/ is se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF :�A T
Thef9 oing instrument was acknowledged before me The for oing instrument was acknowledged before me
this 1p day of b6���2— ,20 /9 by this R day of h9Z-6A46r- _ 20 Irby
Name of person aking statement Name of perso aking statement
Personally Known OR Produced Identification Personally Known GOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of N (Signature of Notary Public-State of Florid
:;.' ONICACASANA
R� Commission#GG 011 A.
"v ., MONICACASANA
Commission N ) Commission No. ,r. s I al)
r June 8,2021 n#GG 0703
_ :+Expires June S.
Baled Thnu Toy Fain Insurance 800.38&7019 2021
�'a:o�N"� Bended Thru Troy Fain Insurance 800.38b7019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17