HomeMy WebLinkAboutBUIDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 121111 Permit Number: / ` Ou Ld'
R EWED
Building Permit Application NOV Z S 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
Address: 151 ���P' ��'► L
Legal Description: I�WreG 1-4 L-i
Property Tax ID #: I.45. 11-503-00 0-0[0—F Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
%QETAILED DESCRIPTION OF WORK: v
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CONSTRUCTION INFORMATIO,N-
-Additional work to be nerformed under this permit -check all apply:
11HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
11 Electric Plumbing HSprinklers Elenerator Q Roof Roof pitch
Total Sq. Ft of Construction: ZI 203
Cost of Construction: $ �,2b ;,
r,
S Ft. of First Floor: _
Utilities: SeweroSeptic
Building Height:
OW N ERAESSEE
' CONTRACF,OR
Name ' r 0me,P7
Address: /Y
Name: RleA"o L41&14
Company: 011r,ct tv+ci SsWkh% 11IG
City: %n Tza IqPuCh State: FL
Zip Code: :3 y 9 59 57 Fax:
Phone No.
Address: l-V(,
City: 5�)'q-r I State: r�
Zip Code: 3"17 Fax:
Phone No.-72-4?M3-'�lrG
E-Mail: �G��i�oE'u-� @D %• ��
State or County License: L'CC /336337
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S'OPPLEMENTAL,CONSTRUCTION LIEN.LAW.;INFORIVIATION' =:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 our Notice of Commencement.
gnatur wne essee/Contractor as Agent for Owner
Signature o rac cense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF MIA,M;/
COUNTY OF filn 4,1 -
The f r ing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
Igo Ven*
this day of R%O✓P�M ber . 20 /7 by
this � day of ew . 20ji by
Name of persmaking statement
Name of per on making statement
Personally Known /' OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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osG�
dA4,ea
(Signature of Notary P u i - StatT�ARr L Fasano
(Signature of N p kR Publith%14%�1A9041ino
Commission No. oo NOTARY g IC
Commission°� NOTARY PUBLI I�
F FLOR�
TATE O� FL RIDA
%'&'.:;1"3CTQmm#
Comm# GG126275
G126275
VF lei1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17