HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED - Y
Date: `�'�' (� Permit Number:I� �C) �Il
RECEIVED
Building Permit Application OCT 0 5 2W
Planning and Development Services
PERMIT TING
Building and Code Regulation Division St.Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED'IM PROVE M ENT LOCATION':
Address: W3h WcgY cove.. Pc• eft 'k6 ce, et_ -YA(1Ag
Legal Description: Cotgk Coie, see ft oA AN\o.k fcvk- op km-ir, b A 5% 1c&1m,,rr'(::ow (lKi4- 4
Mf VK
Property Tax ID#: IWQ S--`to\-006U-o40--G Lot No.
Site Plan Name: GAhg- `( ) Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D,ESCRI;PTION.OF WORK ; m
�i exnoae. e')-sk\,k9 {oo,�nj 5Laac*1 1ns0,%t 0 KCO f(aAaraldY1
CONSTRUCTION INFORMATION',,-,
Additional work to e e orme under this permit-check a apply:
�HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator R_Roof �(� Roof pitch
Total Sq. Ft of Construction: 15-CO S . Ft.of First Floor: 1`6C
Cost of Construction:$ 1 a,00n Utilities: Sewer Septic Building Height:
OWNER/LESSEE; CONTRACTOR:
Name /Jy\LAi E CmideW- Name: 12\cerAo Lew&
Address: ago4, \Au4\ocxw '�vle- Pf• Company: 64k_ cooA"s 5otjAlaV1r
City: ' b4- - la<'� State:k Address: 5s12 so twcoln Yee_
Zip Code: '3p'14% Fax: 112- City: skue v-�' State: 'CAL
Phone No. 3�k-(.43-�K63 Zip Code: 34994 Fax: 2$Y-alar
E-Mail: — Phone No. If-67
i
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C64-11a-3o3-3--f-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
I
SUPPLEMENTAL CONSTRUCTION 'UEN LAW'IN'FORNIATION:
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
cornmencing work or recording our Notice of Commencement.
Signature o er/Le ontractor as Agent for Owner lgnaturf or License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF M4)(fitn COUNTY OF cvrar.y 4
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �be� 20_a by this 95' day of �2,17 �.,ve/ 20_ by
Name of person making statement Name of person making statement
j Personally Known _OR Produced Identification Personally Known C OR Produced Identification
j Type of Identification Type of Identification
Produced Produced
I
(Signature of Notary Public-Sta Si ture of otary Pub ic-State
�Y P` MY THERESA DE RITA a r::Py•, THERESA DE RIT
Commission No. �' ea COMMISSION 9S9om ission No. YCOMMISS{ON#FF 6 9
=.. gal
EXPIRES:October 29, 17 5:; EXPIRES:October 2 2 7
aPf „ Bonded Thru Notary Public Unde 'ers ?,F h ` Bonded ThN Notary Public U e ricers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17