HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ►•�
Date: • �• �� Permit Number:
c E EVZE D
W. 1AINUL 010 DEC 1 1.2017
Building Permit Application Pi_RMI,TENG
St. Lucie COUilty FL
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax:.(772) 462-1578. Commercial Residential
PERMIT APPLICATION FOR: I conc
Address: Y-W VU I M 'K
Legal Description: 5 D ° 113V - 333 0001 _ X t
Property Tax ID #: ay13 11 333o 0001- 0D0 ~ Lot No.
Site Plan Name: Block No.
Project Name:
�"acks Front Back: /_�� Right Side: N® Left Side: 6
Y V ll.f v-w- SAS *Q c S
or
9S .�. 4.
Aaamonai worK to De perrormea unaer mis p-ermii — cnecK aii mat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing
_ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ` `� Sq. Ft. of First Floor:
Cost of Construction: $ 0 �"� Utilities: —Sewer _Septic Building Height:
OWNER1AIU&SEE:
CONTRACTOR:
Name 90f ra
Na"me: ;.
Address:
Company:'
City: 1 Al
State:
Address:
Zip Code: 6 V901?- Fax:
City: State:
Phone No. 0?6 - . 9-
Zip Code: Fax:
!✓ E-Mail: MI
E41
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or Couhty"License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name: '
Address: I
Address:
City: State
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
I
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 grantinng 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 Assodaition 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, signIs, 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 inspp tion. If you intend to obtai,in financing, consult with lender or an attorney before
commencing wQrk�co�r�gour Notice of Commencement.
r9g nat tR'eyo Eng1"�e_'Lessee/Co ctor� s Agent for Owner
Signature of Contractor/License Holder
STATE y�F FLORIDA
STATE OF FLORIDA
COUNTS( OF
COUNTY OF
The forgoing iiistrument,was acknowledged before me,-.
_
the forjo'Q';in'strument was ackriowl.edgadabefore me,," - f;
this=. day pf .'`.n 20 by. r
this day of 20_ by
Name of person making staientht. I
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati
Type of Identification
Produced, n Lr
Produced
(Signature of Notary Publit
pY •V REN S. NIELSEN
iignature of Notary Public -State of Florida )
`�,C i
Commission N FF 115637
Commission No.
'-" '' Q�edJpmmission Expires
mmission No. (Seal)'
p;= June 12, 2018
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
VIEW I
REVIEW
REVIEW,
REVIEW
;: REVIEW
DATE
RECEIVED
j �I I�,I
A V� I 1
DATE
COMPLETED
I
ev.
P'
APPT. DATE �>
INSPECTOR
_TIME
= = =_ _ = _ = =_
ro
TECH
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noun IN� �to to"to to
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ON ■
Services, LLC
Martin 772-287-8486 • St. Lucie 772429-7716
Indian River 772-567-7392 • Pahn Beach 561-746-7364
Corporate Office
4001 Virginia Avenue, Suite A • Fbrt Pierce, Florida 34981
FOR FAST, PROFESSIONAL SERVICE CALL
CUSTOMER INFORMATION
,00 .a
NAME q�
ADDR SS
CITY STATI
3-76 - 3322
HOME TEL N WORK TEL I
L
TAKEN: ) dn BY:
Amt. # 795'�7 I
SERVICE REQUESTED
r\ i r C --e-- � C -r_ C, _�
3 �9ge
PAYMENT / CREDIT CARD INFOl3,h
SVC AMT CARD TYPE CHECK
2.
CONTRACTS:
-7 4�+XS
TIME
4.
TOTAL DUE TOTALAUTH. DEFERRED DATE
CARDHOLDER NAME (If different from above)
I AGREE TO PAYABOVE TOTALAMOUNT ACCORDING TO CARD ISSUER AGREEMENT (Visa/MasterCard Customer Inquiries Call 1-800-920-1079).
141CILla1Ite10=11
VALUED CUSTOMER COMMENTS:
SALES TECH COMMENTS:
PEST CONTROL / FLEAS / OTS TERMITE / FUME
TREATMENT SITES
MATERIAL C�TED Evidence Treated MATERIAL
TREATED Nan a (%&Am
INS{F1
(Y/N) (YIN) Name %&Amount
Mulch/Flowerbeds
iatlon
oun
Woodpile/Garbage Area
Crawl Space
Doors/Windows/Eaves .
Interior Walls
Attic/Crawl Space
Door Frames
Underneath Appliances
Window Frames
Wall Voids/False Bottoms
Bath Traps _
Cracks/Crevices
Attic
Drawers/Cabinets/Closets
Other
Other
,
TARGET PESTS
Time/Beg: Comp: TOT.
Endorsement hereon ack WIKCas
receipt of a faction for services I certify the abovice_tgbe true and anTcate r ord of m operations.
`rendered
�
16--L7) `mil
CU OMERS SIGNATU DATE WIPEOUT TECHNICIAN