HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED )
Date: l '• �� Permit Number: [ �D D ,
SCANNED /
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Building Permit Application
Planning and Development Services JAN 2 2 2018
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: -79-0 6 ® C,A L.sg AID
Legal Description: LA KE W O p j) TA2% AD p `I A0 0 "0 .l - G i-1 L G L O7 4
_ �v2 �2� ��ISbO� SINGLE-FAP►�ll�
Property Tax ID #: 1 .3 0 2 - S 10 r ' GO .T 7 — D 00 Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
'DETAILED DESCRIPTION OF WORK:
2(A'\OVE:
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S[)1�J('u
YZ00( � PEPLALZ
1pIT
1146V 5-V
MEJAL
? 6 NC-(-S.
CONSTRUCTION INFORMATION:
Additional work to be ne rmed under tispermit-check all apply:
❑HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
❑ Electric ❑ Plumbing ❑ Sprinklers ❑ Generator r Roof Roof pitch
Total Sq. Ft of Construction: 2 (-O O S . Ft. of First Floor:
Oa /
Cost of Construction: $ �� ClO ; Utilities: _ Sewer ❑Septic Building Height: 2
:OWNER/LESSEE:
x; , .
CONTRACTOR:
Name ®BSc' I-l7 0 d /V �A L� Z
Address: 7 5'v S p C �9 LA /� ��
_ _
Name: EA1 �
-n-
Company: 41 V 6L012 10,4
City: 7 j/ c /L Gt" Stater-
Address: to ®/ -2 f
V 17c`. 30 00
City: VE-11-O OCAa E-r
State:
Zip Code: V?( I Fax:
Phone No. _ ip % - •� 1
Zip Code: 2- fo Fax:
E-Mail:
Phone No. % % ?- "
Z /q
Fill in fee simple Title Holder on next page (if different
E-Mail: /M Y ri- ,ftoOF/or b 60NIOC70
from the Owner listed, above)
State or County License: d C r-
i 3 2 .6
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN
Name:
Address:
City:
Zip: Phone
Not Applicable
State:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: A r nn Phone:
FEE SIMPLE TITLE HOLDER: f i `I�loeApplicable BONDINt LOMPANY: 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, c It with lender or an attorney before
commencing work or recording vour Notice of Commence ent.
.® _ / _/e 'e—_ I ` 1 / .11 I / _ _ . i r
re qf,OwneW LesseefContractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF —Z>_:�_ �+1-1 ve
The forgoing instrument was acknowledged before me
this S day of 20 01 by
........
Name of person making statement
Personally Known V OR Produced Identification
Type of Identification
Produced
Td
(Signature of Not Pub ' tate of Florida )
Commission No.
My COMl1+?IS; 40N # FF897696_
EXPIRES July 09_2nio
re of Contra cto rrLicense Holder
STAV'OF FLORID 9
COUNTY OF
X� a
-moo
The f9rp oing instru
t was acknowledge iefore
%
this o�day of
20 by
w Z
Name of perAn making statement
Personally Known OR Produced Identificati
Type of Identifl atl li_�M_
Produced
(Signature of Notary PVc- State of Florida )
Commission No.(Seal)
REVIEWS FRNT EGETATIEATURTANGRO
COUO ~ TER REVIEW S REVIEWOR I REVIEPLANVI V E EWON I S EV EWLE I MREV EWVE
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17