HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE:ACCEPTED
Date: Permit Number: OISJ
Ell nECENED
Building Permit Application OCT U 4 2017
Planning and Development Services
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Building and Code Regulation Division
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2300 Virginid'Avenue,Fort Pierce FL 34982 St. L uc,Q C urty, 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:
Address: 139 OS mi w&X odyr,TLc mil_A L
Legal Description: I-t r_l?,0ur, RIDLE PLAT ND -_1 L®T 3 (0P,(=d3- 41 O)
Property Tax ID#: `IQ cam- LQ I - QC63- 000'-4' Lot No.
Site Plan Name: Block No.
Project Name: HAegs--SDIJ RkjS-j_-®a\)C..E
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
csve, �cui olatinv Ao&c*� , (Ze N" 40 Cork, i✓iUtLOQ NAL,) LU4& "g-A ,
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CONSTRUCTION INFORMATION:
Additional work to (e neFFo—rmed under this permit-check a apply:
11HVAC L_J Gas Tank Gas Piping _Shutters a Windows/Do s
Electric 0 Plumbing Sprinklers Generator Roof d Roof pitch
Total Sq. Ft of Construction:c1laq S . Ft.of First Floor:
Cost of Construction:$ ��I ��. Utilities:ln Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name a NameZ. J L)
Address:IS4 S OLD bDAX rv)Y(ZTL6 °TMATt-, Company•. DIL k QFXM& S4STBUS
City: pptrA L'.2N State:,F- Address:,.:�4® P,13c� 12QrAD
Zip Code: :�499 D Fax661 - 1q- I CQ,3 city:l c.NL State:al_
Phone No.6(ot qiz qq &f'-f�-{ Zip Code: ( p��1 tFa�x&1_1 Lf'- ( DR 8
E-Mail. 640 � �D`�-i�gSl�ip�- mS:f1e� Phone No,(ok-�_O- LtLA
Fill in fee simple Title Holder on next page(if different E-Mail: S• 00:.
from the Owner listed above) State or County License:0 etg
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 gprecording your tice of Commencement.
Signat of Owner/Lesse ntr as t for Owner Si ure of Co ct cense Holder
ATE OF FL STAT LORIDA
COUNTY — cou'kJIV COUNTY OF 31-. WCX(�F_ COWO I'Y
The , rgoing ins m nt w s acknowledged before me The f oing inst m nt ups acknowledged before me
thi�day of 20Aa by this day of 20t} by
Name of p on making atement Name of p r on making atement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati n Type of Identificati n
Produced Produced
(Sign ure of Notz ry�� �F- ��A o a ATTHEWS (Signature of N a kljc- gAf( pjd1AIA1THEWS
`'��'
•': MY COMMI ��Q GG127632# '• C'_ MY COMMISSIOcN� )2021#1GG127632
Commission No. " Commission No. EXPIRES J�{
EXPIRES July 24,2021 '•.,,r .••.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17