HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFP P4UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -t
Date:14*0 a. a}I)t Permit Number:
RECEIVED
Building Permit Application DEC 2 7 2018
Planning and Development Services ST, LNcin c-ouhty, 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT
• L,c LOCATION:
Address: t�C. a- M
Legal Description: 3 Q r-vo- � 1Cll.!!J I'? bY' a�-113
Property Tax ID#: U - �� - 3 Lot No. 3
Site Plan Name: Block No.
Project Name: '
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
-.naku-4 cp-en to vv j 9aSwl-e►m (Ylejv� CLc coyci Lo-n
CONSTRUCTION INFORMATION:
Additional wor toe e orme under this permit-check a ply:
HVAC 13 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
0 Electric F1 Plumbing Sprinklers 1i Generator Roof Roof pitch
Total Sq.Ft of Construction: �7 q S Ft.of First Floor:
Cost of Construction:$ / • ` Utilities:ll Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: a Company: LPVJif501
�7 2
City: ( State Address: 0� I
Zip Code: 3�, �� Fax- City:>m I and o State:�L
Phone No. 7a a O Zip Code: Fax:
E-Mail: Phone No. a S3 a2a
Fill in fee simple Title Holder on next page(if different E-Mail: /tiI0-t/.LA4 1
from the Owner listed above) State or County License: 00 C-
LJ
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: T 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 wit lauthorizetheermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants 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 res-d-Jrl your paying twice for
improvements toy Ir' rop;r2lyulcotice of Commencement must be record an poste 0 r I
before the first in ct in.if 'th len r o an a P me before
)/ect in rid to obtain financing,cons
or r�
C r I
commencing wo or r car i g yo e Notice of Commencement.
V y
Signature ofO ner/Lessee/Con tractora for Owner_ Signature of Cont ctor License Hoffer
STATE OFF ORIDA - S7 STATE OF F IDA iC J-112
COUNTY 0 Q Mate_ COUNTY OF
The forgoing nstr merit was pcknowledged before me The fir ring. st ent was ac�nowledged before me
this 20 by
this 12 da of Le CelAige V_ 21�11 by _da of n
ns
of
6 Name of person making statement Name of person making statement
Personally Known
OR Produced Iden c'4tion Personally Known )e OR Produced Identificat'
)!(-
Type of Identification J Type of Identification
Produced
Produced
J1
4/CUA
ignature of N ary Public---a e #Fl Signature of a a u !'c-S11111 a a
J,&# Notary Pubitc Stat fyid spg P&,� Notary Pubhc State f F 0
Commission o 'a Commissio NVP '1� Kagi�4 Riccabonio �9e"al)
"icca ont My Commission FF 981647
My commission FF 981647 Expires 0512812020
%F�*O Expires 05128,'2020
REVIEWS FRONT ZONING SUPERVISOR 1 PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
VED
DATE
COMPLETED
V_812/17