HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services /
Building and Code Regulation Division VS/
2300 Virginia Avenue, Fart Pierce F134981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line II�
PROPOSED IMPROVEMENT LOCATION:
Address: D5 V
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Ulu_,CX Ulut usttat new 12cu Lig v►, t � sl �� a cracac
CONSTRUCTIONINFORMATION: ` 11
ate•. .• o o� row t6•� „o..,,tr - e11 +�f T ,
LIHVAC L.1 Gas Tank L_fGas
Electric 0 Plumbing 0Spr
Total Sq. Ft of Construction::
Cost of Construction: $ 4M.0
Piping
ars L I Generator
SQ. Ft. of First Floor: _
Utilities: 0 Sewer ElSeptic
QWindows/Doors
ORoof
Building Height:
OWNERAESSEE:
CONTRACTOR:
Namel t C &hvirn
Name: Kichad
Address:yisiu;
�-"
Company: ( dl � M�u .].f�l�.
Qs,:��J5f�\4CJo_
City: I' , rt t State: RL
Zip Code: A1451 Fax:
Phone No, i+11- ^ og- qV4
Address: 5106 A 1CLfr1 IAkil, J
City: YUrb— Rtrc / State: t:;t_
Zip Code: "3 4q 5 1 Fax: 77-L- 4& -373_7
Phone No. -m- 41af-414-+
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail:
_
State or County Ucen e: CA --,1$191 A
If value of construction is $25011 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
DESIGNER/TNGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _.Not Applicable
Mame:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER. y Not Applicable
Name:
BONDING COMPANY. _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zlp: 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 Oro representation that is granting a perritwill 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 you- 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 rises to another nen-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 posited on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing worts or recording our Notice of Commencement_
Rev. 8/2/17
Signa ure of Owner/ Lessee/Conuactor Agent for caner
Signature of Contractor/License HoWIR
COUNT of FLORIDA
COUNTY OF
� �uCs2
STATE OF FFc,RIDA 5t (�uC12
The forggoing instrument was acknowledged before me
The forgoing instruugreni was acknowledged before me
th41*9 day of -'TAA UL
2010 by
this4day of `J CtYI •20 Zo by
(Uichtlel
F" &vie,
micl" e &o !tom
Name of person aking stAtement
Name of persoyfinaking stat mens
Personally Known
OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
C'A•
Produced
i
{Signature of Notary P
State of Ftorida)
(Signature o N to Pu f State of Florida I
Commission gl'a"yP a's
CHAISTINE"J. �s f LL
d•—� �®
TI NE
CommissiUn of"sr'n"o'e CHRISTINE J. C�L
blit - State of Florida
, , St" a of F oritla
: •=
Commission # GG 0178'J9
_
y" Commission # GG 017839 s
M Comm. Ex ires.Au
'�+r °' M Comm. Ex Lies A
'se p.` Y
Bonded
rough National Nota
y Assn.
"'^"` on
ed through National Nola
y Assn.
REVIEWS
V1SOR
PIANS
VEG A
GROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17