HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J+, Permit Number:O
Yl„ d'itpG Y
Building Permit Application DEC 15 2017
Planning and Development Services PER.90ITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR:
'PROPOSED;IIVI,PROVEMENT LOCATION
Address: g��y0 i- I clde-n T, I
Legal Description: H IdC en -?B neS V-- A Lq+ E5-
Property Tax ID #: �3_ Lot No.
Site Plan Name:: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
`DETAILED DESC1111?t O- OF WORK:
v kC�
CONSTRUCT O' N,INFORMATION .
Additional work to be nertormed under this permit - check all Jld app y:
11HVAC I.J Gas Tank Gas Piping Shutters a Windows/Doors
Electric PlumbingSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S�Ftj of First Floor:
Cost of Construction: $ go Utilities: L_JSewer Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name II
Name: of
a
Address:�33�,..Ic
t
uQl1''15�
A
Comp any:
City:�f> ..: `. , J2Z
:., : J, I State: f_Ld
Address :-*4, o
Zip Code:
Fax:-f�OZ-�5 CS-LQLR�ii
City: P"EfC`e-
StateE,
Phone No-T C6,2�3-3440
,�1//�4�-
Zip Co `[Qia)
Fax:-7-7a-3i8-ttiV7
E-M il:
e 11,Um
Phone No. --79/ - 63�- � 44 0
E-Mail- b' _Q 146 • 4?0&QIq
eb9229l •�
Fill in ee simple Title Holder on next page if different
from the Owner listed above)
State or County License: :Fd3ab(P
2Tq
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
i
,
SUPPL'.EMENTFAL'CQNSTRUCTION LIEN L W�INFORMATION - '_ •..'' � ° l'
�. #,
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City,: State:
City: State:
Zip: Phone i
i
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
is in Home Owners Association bylaws that such
which conflict with any applicable rules, or and covenants may restrict or prohibit
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 Flo'dcla 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 r ording your Notice of Commencement.
Signature of O er/ Less a/Contractor as Agent for Owner
Signature of Con ractor/ icense Holder
STATE OF FLORIDA
STATE OF FLORIDA ���/I , .10
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The for i instr e t as acknowled before me
Way
this day of 20 by
this of 2y
I cy,-eo
Name of person making statement
Name of p rson making statement
Personally Known OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification / ,,,
C$L (�1�--� l o"�% n
Produced
Produ e S
(Signature of Notary Public- State of Florida)
(Sig tur of Notary Public- State of Florida )
Commission No. (Seal)
►�!
Commission No. ?4••••'o JENNIFE ON
�56192
missionYi
Expires tokr30,2021
OF n0Q�es
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE 4 ,
COMPLETED
Rev. 8/2/17
ky
DESIGNER/ENGINEER: " , • Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
rnmmPnrina Wnrk nr ro0ording vnur Notice of Commencement.
Signature of 0 er/ Les-fa/Contractor as Agent for Owner
Signature of Con ractor/ticense Holder
STATE OF FLORI I . ,
�W `� v
STATE OF FLORIDA
OF
COUNTY OFC�
COUNTY
The f tr t w acknowledge�ef_ore me
The for i instr e t as acknowled before me
Way
this � 20 �y
this of 2 y
Il�-L ClhZj- T -, Al1 4-1(_ ryrt.
W iCV)-eo I .4-'-1%36irY19_('\
Name of persopTnaking statement
K,
Name of p rson making statement
Personally Known X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
14L SO l0V� In
Type of Identification
Produ e S �.1 I �� l O� n
Produced EI
Commission # GG 156192Ar
"
_ r
oFF,o�`°� sWeam B4dgdrOdobea��3errvvios
(Signature of Notary Public- State of Florida
(Sign turq of Notary Public- of Florida )
Commission No. � l
a,State
Commission No. a •.�+ JpNNIFE ON
ommissionI Y56192
* *
�opFto�'�e Expires October 30, 2021
'
9uidediMu
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
.rya,„ — rD�E 41 1712-OqI5_