HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE.INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� �: 17 Permit Number: 1 V
p Building Permi
Planning and Develot Application NOV 0 7 a017
mentServices
Building and Code Regulation Division PER-MITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, 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: �� %!�� /�/Al 15' r'/e /z �i?L 9 51- 3 e/ 9 Sl 2-
Legal Description: TAI&/#!i/ RiI/ /L r&,g+0r. t9A/1r o 2 - AJ.X II &OT /7 .4/Vd toP AoT/,q
XA1,0i.4« R 1119 A F9r,4rs2s 0Airr02-Ai_w- 12 S 1/A-r oPtco-r'iVe . MIA11,4/4frATAnTJ
Property Tax ID #: n-1 U/-_- UCJ *
Site Plan Name: r &/bo
Project Name: 6oW M4k4[415 ir,+
Setbacks front Back:
Right Side: Left Side:
Lot No. Ode, 1
Block. No. h
DETAILED DESCRIPTION OF WORK:
/Vo ""z u'1'6/"YP
8r� s l Coil/ q247 9 s iAS, /I/o ---4aar e'-1 I -
CONSTRUCTION INFORMATION:
itiona wor to. e e orme undert --checkis.permit
E1HVAC Ej Gas Tank E]Gas Piping
a .
apply: .
_ Shutters
❑ Windows/Doors
EElectric ❑ Plumbing
OSprinklers
Generator
igL�kRoof .� Roof pitch
Total Sq. Ft of -Construction: .Z ®®
SQFt., of First Floor:
�
Cost of Construction: $ �
I I
� Utilities: �I Sewer Septic
1 �/
Building, Height: 13 y
OWNER/LESSEE:
CONTRACTOR:
Name: R0 10 + MiLelel
Name:
Address:.6/670
Company:
City:. Fr., 12 cv/--- State: F
Address:
Zip Code:. 3 y 9,t L Fax:
City: State:
Phone No.&A/-35'-16At1Aw-51g9'-SIS7
ZIP Code: Fax:
E-Mail: /"Ar-R le.0 rq&rng g 61,0ogi&ome4e_rr &yl,
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:. .
from the Owner listed above)
State or County License:
it value of construction 1s.W500 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: ARCN/rFCt0,V/e
/y7/eJI-4FL
Name:
Address: Saab DA1-4, w4A,,
City: a r, Pit-'20
' /d ka
State: FA-
Address:
City: State:
Zip: 3=�9so Phone 77A-
Qi,-0- 7
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 recording vour Notice of Commencement.
el C-
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE -OF FLORID 1 STATE OF FLORIDA
COUNTY OF Li1Cl,1 COUNTY OF
The fo oing instru e t was acknowledged before me
this day of 20-Irl by
Name of person making statement /
Personally Known, OR Produced Identification
Type. of Identifi t, n
Produced_ C >•�
(Signature of Notary Pu lic- Staie`oT Florida V
K E S. NIELSEN
Commission No. .=o�'"T "'%�- ,1
^= Co ion N FF 115637
e• *=
- - My Commission Expires
June 12, 2018
.The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature. of Notary. Public- State of Florida )
mission No. (Seal)
REVIEWS I. EGETATIEATURTANGROCOUNTER FRONT I ROEVI W ZNINGS REVIEWUPERVISOR- REVIEW V REV EWON
I S REV EWLE I MREV EWVE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17