HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number: 7 /6 " 0 7 /
Building Permit Application Oct*
Planning and Development Services 2017
Building and Code Regulation Division Pi:RTWI-iTING-
2300 Virginia Avenue, Fort Pierce FL 34982 5t. Lucie C;auniy, 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: L I I �r. kl, CrC L 41 �
Legal Description: U] I tkM R_1V N IRS -UN 1 0-1 1-015 2, AND12
&_c)5Ac- yl �Wlg( S-F) CM P �y f o2N� (oI238�1 -13�3�
Property Tax ID #: 02 - LP 08 - ObS LP - c)og - Lp Lot No. l , 2, ( 2
Site Plan Name: NULI Z i Block No. -�]—
Project Name: A Z
Setbacks Front- R- 4 & 3_ Back:
DETAILED.DESCRIPTION OF WORK:
Right Side: -7 5.0 Left Side: 5c;? , 30
NEW Slts &Le I L,y �Zi s IC>EUcC- _:�' i2>EQ, 2 " 2 C A2 &NrZ_ANG E
CONSTRUCTION INFORMATION:
itiona wor to e e orme under t-checkispermit
11 []Gas Piping
a
apply:
Shutters
Windows/Doors
HVAC
Gas Tank
_
Electric � Plumbing
❑Sprinklers
❑ Generator
Roof Roof pitch
Total Sq. Ft of Construction: �r7 �tp
S . Ft. of First Floor:
2 3 S
Cost of Construction: $ 26b , (DO U
Utilities:
0
Sewer
®
Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namey_�-YUndoy-1 & 9colt AL-L,VZ-
Address: 3LIgy QV CaASk l l OY.
City: R- YA cS� . L ub e State: FL.
Zip Code: 3 yqS�3 Fax:
Phone No. - O�>
Name: Klice- M I I'Cu-M-ta_
Company:arc)up one r,(paSL(()Ct" on
Address:l S FOdC OAL �1I A)t A
+i--- I U
City: b 't &2in1 Lucl � State:,
Zip Code: JI- 952- Fax:-1_72 1`4?- 2'10(
Phone No. �1° -"I "- ~I -72" ?i—ID" ?���
E-Mail: �'Yllk� i'Y�1i'Gi►1dG� 301�1 �Q('�,Ctrl'1
E-Mail: J7 e. 5®v
Fill in fee simple Tit a Holder on next page ( if different
from the Owner listed above)
State or County License: CBCI2S0(.09E
If value of construction is $2500 or more, a RECORDED Notice of commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:�qur lIY)& OCS f) V F
_
Name: C � P
Address: 2 O S
e 3
Address:tiin
City: O ink It
State: V ,
City Po 'r(' -c State: J�
Zip: 0 Phone
—110 ��
Zip: Phone: `I'I'L—W1 •-SNSY
FEE SIMPLE TITL# HOLDER: _
Not Applicable
BONDING COMPANY: Not Applicable
Name: N ,F kn
v -,L7_-
Name:
Address: c4+5kill
Address:
City: pv_17 ie_ C--
City:
Zip:ci53Phone:
332' _3
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 op4he jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an at5�5r6y before
commencing work or recording vour Notice of Commencement.
X�
- � /4", �14 4 � //0
—
Signature of Owner/ Less a/Contractor as Agent for Owner
Signature ontractor/Licens Holder
STATE OF FLO[tljni IDA
STATE OF FLOR A
COUNTY OF 1 (I CI'2,
COUNTY OF r�/�'
V� d'I n U A n Pi
The forgoing instr ment was acknowledged before me
day t F i� 20—a by
The f r ing instrument was acknowledged before me
this day of CC',t0bC-,V- 20_U by
this _�v of
Bron Au ttz-.
M & C
Name of person making statement ` /
Name of p �rsIon making statement
Personally Known OR Produced Identification X.
Personally Known )( OR Produced Identification
Type of Ide tification q, f _
L * A�32- DU5424- 3a-cc
Type of Identification
duced
Pro ced
—Pr
(Signature of Notary Public- State o
ature of Not ry' Public- Sta e o lorida ) NICOLE ELLENSON
No.
NICOLE ELLENSO
IpyCOMMISSION #GGO
9or
9
Y �v
�M'' COMMISSION #GG0891Commission
mission No. - (S�)RES: APR 02, 2t121EXPIRES:
APR 02, 2
1Bonded
°� Bonded through 1st State Insdranc
through 1st State In
urance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17