HomeMy WebLinkAboutBuilding Permit Application ALL APPLICArrB11)LE��,,I..N__FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �j I
Dateq oc�A 1 Permit Number: a 6 0 • u[ua
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Building Permit Application OCT U 4 20V
Planning and Development Services
Building and Code Regulation Division PERHIITfING
2300 Virginia Avenue,Fort Pierce FL 34982 St.Luc, C unty,FL
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:
� -1 Address: Q LFFL-e?— Og=i- . t �
Legal Description: NP otoR L -r 1 CoCQF-Q0oq"—`1ti0
Property Tax ID#:3-1 d S -�103 — Cos of -- 00c) — ( Lot No.
Site Plan Name: Block No. �
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
) tj ajak-Q, (10� Cie cce,ai�o rn&a.0j-D (-e-pla,ee_OW U)5 1 .r c iL m o Q�
CONSTRUCTION INFORMATION: -
Additional work to be performed under this permit-check all apply:
OHVAC 0 Gas Tank Gas Piping In_Shutters :0i
ndows/Door
❑Electric El PlumbingSprinklers L Generator of Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ �. �. d� Utilities:n Sewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name�1_P&)eT fX)UUAC f— Name:
Address-q ��{C FF 1�. C6U��—T Company-qWL � S%ISE-S
City:poi-T-sT, L9-R,CK-- State:VL Address:3LfQ P-7M-r-- RQM
Zip Code: , Faxc�'p —qgq— tC7q$ City:I)! �"(�Qp4m 9NPA Stater
Phone NoSot--4�q— SLLtLi Zip Code:33Lf i I FaxRpi-}$LI— 09$
E-Maie- �" ,(apt Phone N0 �� � 3qI-f'y
Fill in fee simple Title Holder on nex page(if different E-Mail. G� l
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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 recoLWgryour Notice of Commencement.
Sign a of Owner/Lessee/Co c or for Owner Sig re of Contractor/Licen o der
STATE OF FLOR A STATE OF Contractor/
COUNTY OF �� COUNTY
The forgoing instrument was acknowledged before me The4foing instrument was acknowledged before me
thislay of 9(rY � ,20� by thiy of 2CAr1 by
Name of erA son making statement Name of person making statement
Personally Known OR Produced Identification PersonallyKnown *A)�, OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary P i e o (Signature of Nota Pu i #Flon
ITT
"•�; N IE LOV '.' ON1vls
No. �oFR;,• )gg `OMYCOBAt ;ION#G Commission o MY gJ
V1
77Commission EXPIRES G143 4 6EXPIRES September 17,2021
September 17,202
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
'J DATE
I COMPLETED
Rev.8/2/17
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