HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: gib_ a$ � d3- C�1a
�� BY �� Permit,Number:
�t LuelpCo tlnt ' RECEIVED
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Building fermit Application MAR 2 8 '2018
ing
nnand Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: To Select f
PROPOSED IMPROVEMENT -LOCATION:
Address: FS J OZ C10g U't ACA.
Legal Description: l•4_4tUo0.k 90,r IL - 101
7 Qq9 - 114do)
ST, Lucie County
mmercial Residential
dropbox, click arrow at the end of line
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i k. iz- 61 lc. q2 L.b4-11 A C N
laItizIJ10r
Property Tax ID #: to $ ' 11..� Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:.
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CONSTRUCTION INFORMATION:
i
Additional work to e e orme un er t is permit- c ec
F] ❑Gas
a
apply:
❑ Windows/Doors
❑HVAC
Gas Tank
Piping
_
Shutters
11 Electric 0 Plumbing
❑Sprinklers
Generator
Roof
y
Roof pitch
Total Sq. Ft of Construction: 25\-7
5c(.+
S . Ft. of First Floor:
wj
Cost of Construction: $ 1 (9,,-700 -Oc) Utilities:Sewer
Septic
Building Height: S
OWN ER/LESSEE:
CONTRACTOR:
Name
Address: fS I t)2 bq (;h,#- f'6 U
City: '1;iov* State: EL
Zip Code: N cIS 1 Fax:
Phone No.
Name: ek b A D'l6aK
Company: V% Qcof�LLG
Address: I`{So SE C'ga awd Ave.
City: Wd 2 State: L-
' Zip Code: 3'-I S a Fax:
Phone No. 1�1 a -Z 13 'lob 1 LO
E-Mail:
Fill in fee simple Title Holder on next -page (if different
from the Owner listed above)
1-Mail: pl, 1I_0'n00ck In I \C, WA I 00C
'State or County License:
If value of construction is $25UU or more, a KtC.UKUtU IYoilce or L.omrncnccuSnnL o 1 cyuu au.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address: I
City: State: I
Zip: Phone I
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
Zip: Phone: i
I
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 priorlto 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 vour Notice of Commencement.
I
j�nature of Ow / essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �c`dd __ ��-((, -
d� d� Ct.�rQ
STATE OF FLORIDA A-
COUNTY OF
TheCOUNTYOF
forgoing instrument was acknowledged before me j
this Qa day of CY1 nnr � 20�by
The forgoing instrument w s acknowledged before me
this 11 day of 7JUL& , 201 by
'�
Name of ers n makin statement
Personally Known p� OR Produced Identification
Name of erso making statement
P g
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced —
Produced r
�, rida-Notary Public
(Signature of Notary P b(i' �egtate
I •= Com fission # GG 192960
C mmission No. • ;� ,QF My mC(o1a►d�ission Expires
/�s ��„°„t��` March 06, 2022
r6"'�"-�
Si nature of Notary Public-
(g ry
Commission No.
I
ALLY MEtSNER
c:o`" ,�B4�c Stat of Florida -Notary Pub
__ P`= Coition # GG 19296�
y'F OPT My Commission Expires ,
''•°Sn�"` March 06, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17