HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: M�-05
OCANNM RECEIVED
Building Per J� Application
Planning and Development Services JAN 2 4 2018
Building and Code Regulation Division ST. Wde ty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resiclei;1771'
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: b
Legal Descriptio'n": Sef C
Property Tax ID #: �q�-)— lit- bool-
Site Plan Name: o t )cl
Project Name: c P_
Setbacks Front- %0 Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED .V
E
tt 1L, 0(6ESCk!P 0
I � "? 4 , olaNinif M
I`1-
®n ey-is4Z45 . '-saoot-.3,
E1HVAC Li Gas Tank F]Gas, Piping
11 Electric D Plumbing OSprinklers
Total Sq. Ft of Construction: a&�
Cost of Construction. $ S i 5.00 —
LJ Shutters
Generator
S Ft of First Floor:
Utilities: . Sewer F] Septic
Windows/Doors
Roof Roof pitch
Building Height:
-/LES -bMtR
CONTRACTOR
Name TOSQ?h Q U be t-1 k,
Name: 6eom4z 2 (:Nv -e C
Address: 6 u rNZ v 91 "'S � Ack
Company: OfQS;f WOCSY
City: —s*, L u -c ie State:
Address: 11 S - & CkS Y
city: f;0,4 P -%' e 1,,,cl? State: R
Zip Code: �ct 51\ — Fax:
Phone No. 'M- 64b- 1366
Zip Code: Fax:
E-Mail:
Phone No. •0 9 & 116
E-Mail:
Fill in fee simple Title Holder an next page (if different
from the Owner listed above)
State <9icense: al S, a, C)
If value of construction is $2500 or more, a HKOKULU Notice OT commencement is requirea.
SUPPLEMENTAL+CONSTRUCTION LIEN LAW INFORMATION
_
r
DESIGNER NGINEEr.R•
_Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: n 'Inn
L.LC
Name:
Address:
Address: l 4
City: i C
State•
City: State:
Zip: 30 Phone q�l
^ `Sq I ` "80
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 our Notice of Commencement.
Signature of wner/ Les§Wco actor as Agent for Owner Signature f Contra or/Li se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ` I �,L 1 COUNTY OF 4, (
The r oing instrun ent was acknowledge before me
this day of 20 by
C ::8f6f9 E- ZR vecz
Name of person making statement
Personally Known OR Produced Identification t/
Type of Identi ' on
Produced T, U Q� ,
The f ing instrui ent was acknowledged before me
this day of 2019 by
Name df person making statement /
Personally Known OR Produced Identification V
Type Identi L Ol
Produced �
(Signature of Public- State of Florida
(Signature of NotaryPGbli =
a-
-Notary
4,,,,�
`,, �arvoo KAREN S. NL EN
Commission �� °�-. ei�
;.��aro�,,, KAREN S. NIELSEN
,• B,%hl) 115637
Commission No. :s �= Commissio(>
sion # 637
3. *_
'•
= My Commission Expires
- My Commission Expires
•-,,,,,,,
2, 201 8
OF R,� June 1
June 12,
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Rev. 8/2/17