HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
12
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Building Permit Application DEC 15 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. L me County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lin
PROPOSED IMPROVEMENT LOCATION:
Address: 8330 J } db-O? 'Fi n-eS 4Q .
Legal Description: H I dciel) ?Ines �-1-oL+e.S _31 1L t-� I• Q ( 7AG C�V
qo4-49- ��`1-�g�1a, IG�14..
Property Tax ID #:23" 2-3'�Ol `" �Q` Lot No.
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Site Plan Name:
lI �✓�+eQVI Block No.
,
Project Name: 14e_ry-lp S
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit -check all that apply:
E1HVAC Gas Tank Gas Piping Q Windows/Doors
_Shutters
Electric 0 Plumbing Sprinklers 11 Generator F]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ �,) 0 • `— Utilities: _ Sewer []Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name ad
Name:7EnPrglZ:�F r �c
Address: �33�� i ddPJ�11l�5 ,
_
Company. �O�i(-4' 101 (l IL _
City: FcY+ -PI15, CIO State PL
Address: 4a 13 21V d
Zip Code: Fax: 11�- �j &(007'&
City: k)V-� plIeV-C•e State p_
Phone No.-I-7 0- 5_4� -3440
Zip Code: 2 QGgG 1 Fax-11 a- ?JIS-(Q(ff-q�
� I G1n
E-Mail: t,Q✓1►�11 .eY1�(QI��'CJN��11'�I�
Phone No. �1a1� 344-0
Fill in fee simple Title Holder on next page ( if different
E-Mail: �nl �1'i�l� lie yVl l�•
from the Owner listed above)
State or County License:
If value is $2 00 or more, a RECORDED Notice of Commencement is required.
oconstruction
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Name:_
Address:
City:
Zip:
1
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone:_
State
Not Applicable
Name:
Address:
City:
Zip: Phone:_
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
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 Notice of Commencement. In 11
Signature of
STATE OF FLORIDA
COUNTY OF
ractor as Agent for Owner I Sign
The forgoing inst ment was acknowledged before me
this -tt day of 201q by
-vipbed i fl& )i ' L
Name of person making statement /
Personally Known OR Produced Identification ✓
Type of Identification
Produced k- k— "L-1
Holder
STATE OF FLO
COUNTY OF - I—LA10-4 C�'
The f nst en �ya� acknowledge fore me
thiA da of ' L� I 20_ y
`Rober+ -T?-:>I n
Name of pers n making statement
Personally Known OR Produced Identification
Type of Ident' `�,
Pr i#orecdd i F OND-� tC tck/0
Commtsston # GG 156192
Expires October 30, 2021
''kOFPt� eondedTfwBudpetNolarfiServkas
(Signature of Notary Publio-"State of Florida a$. NIELSEN (Signature of N��a`ry�Ibl��tl FloridaSeal Commission No. KART ) Commission N )
+° Commission # FF 115637
e* +=
,; My Commission Expires
Aiina 12.2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
C I REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17