HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST OMPLETED FOR APPLAXtION TO BE ACC J:D
Date: SCANNE
[j Permit Number:
- St Lucie C ➢ W
_ .......... _ ..-..._... ............
Building Permit Application
Planning and Development Services
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: Generator
-:;
PROPOSED IMPROVEMENT LOCATION ;w
sap
Address:
Legal Des
Property Tax ID#: LJLk3(o — & bl — WLl-i— 000— Lot No.�
Site Plan Name: / Block No.
Project Name: �%ybeze A o%S4G�% 0-e - ,, Aay-
Setbacks Front 3 d Back: Z.C> Right Side: Left Side:
j
DETAILED DESGRIFTIO.N OF:IIVORK =e fi h
l o / 7 5 T4 �I ! h_A Cr4 e- e ft c ,- �/ ���j �� evo �P� �✓!�� ��t c/��G
# 7S 610) /SU ct *vs
CONSTRUCTION ,,INFORMATION
n _a
itiona workto jertormed under this permit— cnecK all apply:
❑HVAC lJ Gas Tank '❑Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers _Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ l 45. E UtilitiesSewer Septic Building Height:
OWNER/LESSEE :, r
_
CONTRACTOR:
NamSCA,
Name: i 14_
_ Cornp.any- iC 1 •+_0_
-0
City: .• i ate:F—L
Zip Code: �3�i5�" Fax:
Phone No.
E-Mail:
State or County License: EL'.oO �688�
.Address: 14C1 a t'v%r%&#A Yl 4 ttwGq 2 _.
City:'_%Ge"a State:G If.
Zip Coder Fax:
Phone No. ��2 22-L1- 2��3
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is sz5uu or more, a KtLUKVCII rvvL1ce U1
`l
?A - {
I ,
SUPPLEMENTAL CONSTRUCTION LtE.N, LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _-Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 perms lit 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 helreby 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 in pection. If you intend to obtain financing, consult with lender or an attorney before
commencind.WoVKor rec4rding your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA /
��
STATE OF FLORIDA ��rr�� �N �Ja4C
COUNTY OF
COUNTY OF ; >vr '&'i `
;?
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
by
this day of � a�znli 20/,5' by
this _2�Zdayoof drr%�-� .20_1
�Z?J
Name of person making statement
Personally Known OR Produced Identification 11�
Name of person making statement
Personally Known ,_�OR Produced Identification
Type of Identification o
Type of Identification
Produced
Produced
(Signs a of Notary - S° teigf F ri��$LI D ZELAYA
ignature otary Puplit. °,. Flgr' I D ZELAYA
a.,:
LO MISSION #FF1651
M_TSea
Commission No..� t :.Nr` •' .. ,
2 MY CO/cMQM,I�1SION #FF165172
C mmission No. 1, 2018
o,
i Fay F`o , E PIR S October 1, 2018
EXPIRES f3ctober
e.com
%'J]) 3JB;Ut53 FloridallotaryServlci.
(407) 398•0153 FlorldallotaryServlce.com
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17