HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nutt
AUG 01 2919
Building Permit Applicatio T. Lucie County, Permitting
Planning and Development Services
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 LOCATION: 1a�- Ccs
Address:_ 3ly(c W\Nn teu-)aau CQ Lt i t.1 F+. Pi c C. . FL
Legal Description: I-1 35 HO [ 140 PT 6F W s12 0'E S ir2 pF S /2 OF SVJ
Property Tax ID#: Lot No.
Site Plan Name: f,)OUgtct$ Block No.
Project Name: Q0UWCL5
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
pty�DA cek, r��a�l t�o code,
,s U New 5V rnekq t Y—� w\t\ %eW -PA-4Q-re u\de,r-lagftwt'- 10:>*qLO
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all tbat appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing OSprinklers ❑Generator Roof y l Roof pitch
Total Sq. Ft of Construction: y i 5(0 5 S . Ft.of First Floor:
bo
Cost of Construction:$ 2(o, (0�5 • Utilities: _Sewer O Septic Building Height: j r
OWNERAESSEE: CONTRACTOR:
,Name Ce\-A-_u_a OmnlaS Name: Q=IRS F_ Rat n-
Address: 3'14b Whi�ewctU 17oif Q& Company: �6k Q-Q Q.dP1t ..Lnc •
City: F= -. Pt ee- State:_ Address: 1334t SF Stater Si-
Zip Code: `649L6 Fax: City: State:FL
Phone No.--I 04- 576 - Z);-Sq Zip Code: 34 Q9 -1 Fax:
E-Mail: Phone No. 7?.Z - 2.$7- 2-8-2-R
Fill in fee simple Title Holder on next page(if different E-Mail: f)tC coc-leA(b&�V_5. C&fn
LIf
m theOwner listed above) State or County License: CCCto a� 5(a=1ylue of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENIAW 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.
1'e4Sign ture of Owner/Lessee/Contractof4s Agent for Owner Sig ature o Contract r/License Holder
r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFMA-l2'f-L4\� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I day ofA1413,tn5-7 ,20LC(_ by this I day ofGv+s7 . ,2011 by
I�)Fc.GGA �1• ���/� � �t..,G��'S �• �l�
Name of person making statement Name of person making statement
Personally Known OR Produced Identification V. Personally Known �< OR Produced Identification
Type of Identification /I Type of Identification
Produced Produced
Sigfare of Notary ub Ic-State of Florida) Signat a of Notary P Ic-State of Florida)
Co n N 2(o5O5S �t� a�EGAN CRAWFO mission No. �0 s5 =�"( I)ECEGAN CRAWF D
MY COMM1SS10N#GG2 SOS MY COMMISSION#G 6 55
EXPIRES:October 03, 0 2 o,,d07 EXPIRES:October 0$22
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17