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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: /,,2---e-1 0 Permit Num _%=D Building Permit Applicatioi i DEC 2 6 2018 Planning and Development Services Permitting Department Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie C ty, FL Phone:(772)462-1553 Fax:(772)462-1578 Commercial Rugfdentlal­ PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED]M PROVEM ENTLOCATION. Address: 13�QQ Alw cd, F d Legal Description: v, _ Al2 dzo1 Property Tax ID#:y%36p- (a o/- o0;Z tj- %oo o Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCR(PTION IF WORK vp JQc i� gam). �, Cox 7 . ��ra��' ra�/o©�� , rte✓ CONSTRUCTION-1NF0ki 'AT 10 Additional work to be ne rmed under this permit-check all app y: HVAC Gas Tank E]Gas Piping _Shutters Windows/Doors 11 Electric Plumbing E]Sprinklers Generator Roof Roof pitch Total Sq.Ft of Construction: S Ft.of First Floor: Cost of Construction:$ �� Utilities:[]Sewer r Septic Building Height: ..OWNER/LESSEE:,. :.CONTRACTOR Name Name: JDA Address: 13.5 0 a 41 Company: J� City: c'� (': Lr, State: Address: /ff/ 7 S&d P1,`/ Zip Codet��,'D Fax: City: t,-t-, iC' State:JP1_ Phone No. _ _33�-/��� Zip Code: /��` Fax: E-Mail: Phone No. 0- el al (® Fill in fee simple Title Holder on next page(if different E-Mail: pr d a 01) �D from the Owner listed above) State or County License: �2 Y 3 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. L _ SUPPLEMENTAL CONSTRUCTION LIEN LAW.INFORMATION: _ 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 Commencersresult in your paying twice for improvements to your property.A Notice of Commencement must be record and posted on the jobsite before the first inspection. If you intend to obtain financing,consult with lend r or an attorney before cornmencing work or recording our Notice of Commencement. Ay /11 Signa re of Owner/Lessee/Contractor a gent for Owner Signatur Contractor/License Hol r 'O STATE OF FLORM. STATE OF FLORID N M COUNTY OF OUNTY OF r+' The forgoing instrument was acknowledged before me moo, • e forgoing instrument was acknowledged f V. m thiadayof Met � 20� by USN is�0dayof. 20�b C?• � n i. _ (D LO rD CL Name of p rson making statement m V5!§ Name of per on making statement p Personally Known ✓ OR Produced Identification zw ersonally Known ----OR Produced Identific�t 4)� 'oo Type of Identification Q oX ype of Identification Produced roduced CD 'o (Signature o1b1tary Public-State of Florid '-°«; 't (Signature of Nov o Public-State of Florida Ll Commission No. (Seal) Commission No. (Se�UbREyg•HUMPHREY 25 *c +_ MY COMMISSION li FF 17477 EXPIRES:March 6,2019 Bonded Thru N rs REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17