HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: OC-.>AIA
" �
RECEIVED
Building Permit Application MR i
'6
2017
Planning and Development Services
Building and Code Regulation Division PERM1T i'aNG
2300 Virginia Avenue, Fort Pierce FL 34982 St.'Lucle Gput'i.EY-rL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lineQ �>
PRaP05ED IIt11,.PR017EM°ENT LbCATION
Address:_ 46006 P— Q ir1CL Dr-i-A, Fw t- Pit(-Ceit FL StAct b2
Legal Description: ,-QI(LQ rOIRkS 91D Rilk, 13 UtS 1 , 2. 3 (Ja 4-
D . LDg ArG) ( 0IZ 3 tv35 - h q.n
Property Tax ID#:34p3- 1501 -0314'9 - 000 - 5 Lot No.
Site Plan Name: Block No.
Project Name: Wth H1)M MEC
Setbacks Front Back: �S Right Side: Left Side: 44:3'
DETAILED DESCRIPTION OF WORK
-D4' ftRC1 Maw accessorq 1�rlia+Ltrov F 011 r?nctoSC& /609 02,eg h _.
CONSTRUCTb1C3N INF�R11�lATION
.�. , 1 a .
iAdditional work to be nertormed under this permit-check all apply:
[JHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers E Generator F] Roof Roof pitch
Total Sq. Ft of Construction: U 00 S . Ft.of First FI or: U00
Cost of Construction:$ (D500 . 00 Utilities: Sewer Septic Building Height: 12
I CONTRACTOR
OtIUNER LESSEE
Name I_ArrL4 1�' Com Ivi Name: W CWel skMOW)
Address: 1020 NW 1$4-h AVQ.,. 430Lo Company:CQL( In I(1Q Ca([)OrfS IriC.
City:Porn DCUID MAC.h State: FL, Address: 2 4105 W ulli H wu
Zip Code: Sto Us Fax: City: COI u.lf State:
Phone No. Zip Code: g4,3q Fax:S&P -51K- 0V%
E-Mail: Phone No. 600 -Lv90 -42(02
Fill in fee simple Title Holder on next page(if different E-Mail: 6M. PO CGL(olinQ CQ(pbrfs. COm
from the Owner listed above) State or County License: CBG'15�1'41L2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRCJCTIORI LIEN LAW INFORIVlATbN.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:_ icimoS ?-. Q. V)I Name:
Address: L005 W. NfQLQVV- AVW Address:
City: State: FL, City: State:
Zip: 3271ZO Phone: 34)1n- qS --Q>u44 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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.
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Signature of Owner/Lessee/C ftractor as Agent for Owner Signature of Contractor ense Holder
STATE OF I"U" A ��Y� WO OIM STATE OF Ft6RtD -- QUth C f001�1C�
COUNTY OF gk'irrW COUNTY OF SIA�sL.I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this; day of MCC(r`kl 20 1TI by this�day of MCL(Ch 20 F1 by
1 Mi Chael �-, .lol'��socn Wchapt R. Oohosrxn
(N a of person acknowledging) (Name of person acknowledging)dg
nb24+
(Signature of Notary
Public-State of Fheri W) (Signature of Notary Public-State of Fier+4e)KC
Personally Known v OR Produced Identification Personally Known OR Produced Identification
Type of Identificaat�tiio�on Produced Type of Identification Produced
Commission No.L61 jA TOLBERT ommission No. O F l�O� LBERT
of r Public, North Carolin otary Pu IIC, North Carolina
trj+ 41
Surry County Surry County
March 03, 2019 March 03, 2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE REVIEW REVIEW REVIEW
DATE �J/
COMPLETE /
INITIALS