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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: iZ 21(� Permit Number: 'Q RECEIVED MOW Building Permit Application DEC 2 8 2018 Planning and Development Services Building and Code Regulation Division ST. Lucie County, Permitting 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _ PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: DPA-So O �L u b. EoA - i M-fe FL 3995 Legal Description: LA&2 uJ O a D PA-Rk — V N i% 9 . 13EY 0 S, WT's to / Property Tax ID#: 13ol— 6 11 03 o7—roods Lot No. /0'& Site Plan Name: Block No. 1 S Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: 6p l✓1(-e1? e X(S r rw�- o UeR#cAb e/-ec7x l c Sex ce 1-© Lmo-eR 64UNb S''AUtc0__ CONSTRUCTION INFORMATION: , ional work to be pertormed under this permit—check all appy: HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors Electric 0 Plumbing OSprinklers Generator 0 Roof Roof pitch Total Sq. Ft of Construction: S Ft.of First Floor: D Cost of Construction:$ O 0,O, a 0 Utilities. Sewer OSeptic Building Height: OWNER/LESSEE: CONTRACTOR: Name ReiVA `6— eR4- TuRm2X Name: Address: ,�Cc y &SO Root—es at" Company: City: Ryu- ei eR ce State: FL- Address: Zip Code: 31gS1 Fax: City: State: Phone No. `1')7— qk° 6'YgS" Zip Code: Fax: E-Mail: /'( gAe_2Z/ e-.CoAICASF.Ne7` 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. 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 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. tg—nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF -4- . Lu e,I r_ COUNTY OF The forgoing instr ment was acknowledgeAbefore me The forgoing instrument was acknowledged before me this ff day of 20 by this day of ,20_ by Name of person making statement Name of person making statement Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification Type of Identific tion Type of Identification Produced Produced C>� (Signature of Notary Pu (Signature of Notary Public-State of Florida) ;1ppy pVB'i KAREN S. NIELSEN Commission No. State JSMyida-Notary Public Commission No. (Seal) Commission #GG 207484 OP` My Commission Expires j� F FSO�� June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17