HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONT
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: y 1 ft
RECEIVE
Building Permit Application I AUG 2 8 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: ��.�►�1av;,4,. .,SUhi. ti11 /-f i.Po, D(�_L''g:c'UC C0;soI?/t
PROPOSED IMPROVEMENT LOCATION:
Address:
11700 p A L-oo -SA c'r
� P
Legal Description: A014.6 y pliilrS - 041 31-o&IC A , k0 J 1S"
Property Tax ID #:
3J09- 60 - DO/a- 00a-3
Site Plan Name:
Project Name:
Setbacks Front C- Back: Right Side: �8 Left Side: 7f 3
Lot No. �s
Block No. /g
I DETAILED DESCRIPTION OF WORK: I
' P4 L(' "/,,' Poor
CONSTRUCTION INFORMATION: _771
Additional work to jbe nertormed under this permit- check all apply:
11HVAC LLJ Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers R Generator E] Roof Roof pitch
Total Sq. Ft of Construction:
t L') V S . Ft. of First Floor:
Cost of Construction: $ *1:z _ -0
Utilities: LJ Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name TJS % lAI S/ L, r
Address: //bql 4j0PA1,p054 67—
City: FDIC 1 S'Y L�fillz State: CL-
Zip Code: 3 `1 % 67 Fax:
Phone No. 3 ,3 7j-07ac)
E-Mail: _J';)sfn4eSIGifLo-TANeo.oaIv,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: � is �uGJ��S�ti°lrzS �iG.
Address: 1377 s -J - ,3li.T/Aop, r sT
City: A6JQ J S ✓ l'J yeti State: J`
Zip Code: �� `� 7 63 Fax: ' F? 7- 6 Mr
Phone No. 377- 689,5
E-Mail: ls-4,4,0s14,0 Gat'"
State or County License: GCaG iSd 761-4
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�_PCOl, V�Km4 I'74�' 65Fi
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
\
Name: %l3 C. pL 4J i iro4d$490414C4
_
Name:
Address:
Address: 60Z ,48BvTr
City: 0_H PHf`ts State: PL
City: State:
Zip: 3 :& Z Phone 813 -' 66%5-u-t
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 R,ptilzL!� of Commencement. 1 1-1
Signature of
STATE OF FLORIDA
COUNTY OF
mtractor as Agent for Owner) Signature of Qrontraolr/License Holder
STATE OF FLORIDA
r kiC,trTz- COUNTY OF Sr. wDrrL
The forgoing instrument was acknowledged before me
this Z` day of Aoc? , 2017 by
.rmAP-LI I �°la L_sc 1k .S E2
Name of person making statement
Personally Known x� OR Produced Identification
Type of Identification
nProd
(Signs ure of Notary
Public- StAte of Florida )
Commission No. �J� #%, Pub'cState ofFlorids
ani Ile King
` My Commission FF 931221
o,pe Expires 10/27/2019
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
Rev. 8/2/17
The forgoing instrument was acknowledged before me
this zf day of AXP 20 /7 by
�P_ Q cJ
Name of p s making statement
wn % Personally KnoOR Produced Identification
Type of Identification
In I?—r
ature of Notrafry Public- State of Florida
on No. 40" 11* Ngfa�r�i4bye Sate of Florlde
D King
` My Commission FF $31228
e.No� Expires 101271201s -
SUPERVISREVIIEWOR REV EW VEGETATIEVI WON I SEEV EWLE I MREV EWVE