HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ���
Dater ( Lel Permit Number: L5 o3 ''(((7
` a .i I " ' RECEIVED
Building Permit Application MAR 0 4 2018
Planning and Development Services
Permitting Department
Building and Code Regulation Division st. Lucie Cn in+,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential �-
PERMIT TYPE:
PROPOSED INPROVEMENT LOCATION:: _ a: .: -
Add
Address: � R 0 11 Sti a floi\Or( 6_, '...
Property Tax ID#: 13'01.- Co 13--0l r-^000kli Lot No.
Site Plan Name: Block No.
Project Name:r'e-h CC
DETAILED: DESCRIPTION OF WORK
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CONSTRUCTIONtINFORMATION
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing,F4 _Sprinklers _Generator' _Roof Pitch
Total Sq. Ft of Construction: / 61 'lg. 6 Sq. Ft. of First Floor:
Cost of Construction:$ f SOO Utilities: _Sewer _Septic Building Height:
OWNER/LESSEES ° il _ CONTRACTOR
Name 5,-, Z . ii4t-p r1 (-.J hq ha / Name:
Address: b �� kg n 77„ty1�t PC” +- Company:
City: 1 , f l e 1'-- State:7r! Address:
Zip Code: , Fax: City: State: -
Phone No. 17 'Z C162 -(O f c9 b Zip Code: Fax:
E-Mail: 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.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
1 '
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIQN. . f ',` - -
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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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 your Notice of Commencement.
Signa re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAs1r ' ' ��� STATE OF FLORIDA
COUNTY OF (7' Vt.t_ J COUNTY OF
The for oing instrument w s acknowledg before me The forgoing instrument was acknowledged before me
this /- day of ,20 by this day of , 20 by
r. ucz_o ryo . Mukrna t)r(n
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio¢, Type of Identification
Produced '-1 X_— Produced
E U
(Signature of Nota Public-State of Florida) (Signature of Notary Public-State of Florida )
Commission Nc&°27C)C9 o,``APIL ELLEN VAUGH
'-'001C. t NCbli `,fission No. (Seal)
aapt to of Florida-Notary Public
' ° _ Commission # GG 270079
'��01Fli'7,.' MyCommission Expires
%�OF FI��' P
'limo October 22, 2022
REVIEWS FRONT ",4 . --'1". " '-. IS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
1ev. 9/26/18