HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 2-,
Date: 2(0'I� (`J Permit Number: L J Z
SGANNED RECEIVED
Building�T,e r �plication MAR 2 6 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 I
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
PROPOSED IMPROVEMENT LOCATION: I J
Address: Ty0 i R AUG,w �T _P,e_,rc;e Fc OG'L(DA- W95 /
Legal Description:
Property Tax ID #: /.30f - (aa = Lot No. 23
i Site Plan Name: He),e—ti ?-.(Mf Block No. S-r
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
64,W,Je , We 7 / 467r /R Aje_ lS
CONSTRUCTION INFORMATION: - -
itiona wor to e nej orme under this permit -check all h apply:
11HVAC LI Gas Tank Gas Piping Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
I
Total Sq. Ft of Construction: /6-59 S. of First Floor:
Cost of Construction: $ S' ODO. Utiliti IgFts: 0 Sewer E]Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name W-4-6-w 44Q& -/
Address: q!t0 i 13 AyG.v P 4cyo
City: + ire e�rG`� State:L
Zip Code: Fax:
Phone No. 11 Z- 1173'777 s
(Name: ielnme- 2_4e os
Company: r0or A✓
Address: 577`/ f 6-81%4yeN--e__
City: Iles^cv Se&CW State: �L
Zip Code: 3 74-`l 6 Z- Fax:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
I
Phone No. '77Z-J5_Z$'- %%6O
E-Mail: 44 7-,6, 1oSl V e A 414e / e-0 M
State or County License: t26,G 1. dO06 Z
from the Owner listed above)
IIIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required. II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: I Name:
Address: Address:
City: States City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: I Name:
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/
ract ent for Owner
Signature of Contractor/Lice Ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ��t1C
k
I ��_
COUNTY OF u u_
The for oing instrument was cknowledged before me I
20_ by
The for oing instrument w acknowledge efore me
thisaQday of MVA'(01& by
this ay of
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120_M
Name of person making statement I
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi JLon
Type of Identification
Produced bL
Produced
(Signature of Notary Public- State of Florida) I
(Signature of Notary Public- State of Florida )
Commission No. .��� �;--.
KAREN �ELSEN
Sell
;# F 11 5637
d��; �--
Commission No. i s`;•F"°� -. REN
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El N
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My Commission Expires
June 12, 2018
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-;o.;,.'Qi �',o,' myComm n FF 175637
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
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OVE
COUNTER
REVIEW
REVIEW!
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17