HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLcrei) FOR APPLICATION TO BE ACCEPTED
Date: 3 `Gas \1-� ������' Permit Number:
P DIV RECEIVED
Building Permit Application MAR 2 3 2018
Planning and Development Services ST. Lucie County, Permitting
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:
PROPOSED IMPROVEMENT LOCATION:,
Address:
L.
Legal Description: -T's,�t0I
1_
1
0
Property Tax ID #: 3 `7 0 (-) 0 q , � li
0Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Bac :. G Right Side:
Left Side.
DETAILED DESCRIPTION OF WORK:
CONSTRUCTIOMNFORMATION:
Additional work to be per!ormed under this permit -check all that apply:
_ HVAC .. _ Gas Tank — Gas Piping _ Shutters _ Windows/Doors
_ Electric ' _ Plumbing _ Sprinklers _ Generator _ Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $S�' Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:-W i r.�. �. c ✓1
Address: (D 10 S' l
Company:` -eA raja -el C,"4 rvw'b'
City: � �' �, Q 0C� State:`FG ;
Addresfs: �'/ 0 Z �A � w. p r-
City: 1 -)L )�i\-e 4- c <- Stater I
Zip Code: 3 LI Q R a Fax:
C
Phone No. " In�� - �C� 1 �,' !
Zip Code: 3 'L1 g e2-- Fax: 772- -12 R - 373
E-Mail: ► (1 o ®rIA l -rb, CO yr
Phone No. 7�2 -370
Fill in fee simple Title Holder on next page ( if different
E-Mail: Yel anxlN G>orw .5 Q ✓ `�� o''�
State or County License: 911k -2 $; $
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 3 ao5
SUPPLEMENTAL CONSTRU
EN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applica
Name:_
Address:
City: _
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phon
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 tolthe 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 lodes 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIPA
COUNTY OF S . LvG c.
The forgoing instrument was acknowledged before me
this W_ day of `f'��'`( , 201'q by
�� G TU�tei�• � " `� O 1f� i
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced D
(Signature of Nota yate of§.JW-dgoy:I MGNENS
aGG 02202:1
My COM1,41SSION #
Commission No. t r-�cPIRE�S`&-r, ber 16, 2020
li ?rF..=a;oYo- Bonded7hmM0ta11JPuulicUr+d�raf
de-9"
of
STATE OF FLORIDA
COUNTY OF K�< 1,
The forgoing instrument was acknowledged before me
this day of tea{ , 20 R by
V _11 i:' ,?' \ 'Na
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced `+ J� L
(Signature of Notbf� Ri61a 'State?of FlirSd� �N LG `'�' '
EXPIRES: December
Commission No. Is16 rt'„dedThntl4o Pu cUn' a
eaq -
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
Y
COMPLETED
3I1q
Rev. 8/2/17