HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- -A
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTER"..
Date; SCANNED Permit Number:
BY voxw ID #..00z?1(,9
Building Permit Application REL'ErVED
Planning and Development Services
MAR
Building and Code Regulation Division 3 02018
2300 Virginia Avenue, Fort Pierce FL 34982 Pen-nitti
Phone: (772) 462-1553 Fax: (772) 462457 Commercial Residimfa4ent
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED -IMPROVEMENT LOCATIdI4.
Address: t r,'r"s, meme V-1 3 Li am (0 IA.- 9q C)
Legal Description:
ILto
Property Tax ID#: V-4,DC-) 1/-4 d�07' Lot hlo,,J��
Site Plan Name: CI-11mr(l rilup- fhIlsk:te' kn^e Block No.
Project Name:
Setbacks FrontJD Back: Right Side: Left Side:
:DETAILED DESCRIPTION .'OF -WORK--
Dip' -6 n
Wide, hone —
CONSTRUCTION INFORMATION.
A00itionalworktobanerformed under this permit checic all t= apply:
0HVAC Gas Tank []Gas Piping F-1 shutters FiWindows/Doors
DElectric 0 Plumbing []SprllnklI [] Generator D Roof Roof pitch
Total Sq. R of Construction: Sq. Ft. of First Floot: 6 2?19
0Sewer D
Cost of Construction: $ 12 3_0 6 Utilities: Septic Building Height:
:OWNER/LESSEE: -
-CONTRACTOR:
Name:_�'OQU tom 77P r_OLJQ-Q
Name WtAnthi CCIJP- LA6%?_ IncMe___
Address: LW1,51us- k
Company: 610*C Wi4e_ 9 3�11G
City: t efr-t State:
Address: ,a t) In v
Zip Code: �S q � Lf & Fax:
City: i State:
Phone No. -7 -1 i ZS--l- t13'1 01
Zip Code: 13915cl Fax: 963 -61fa -02 6 1
E-Mail:
Phone No. &&, 1946- (204
Fill in fee simple Title Holder on next page If different
E-Mail: un Laws R9 W&VIcit I - cpm_
from the Owner listed above)
State or County License: .3o63 cp
N value of construction is $2W or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION .LIEN. LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: ) Not Applicable
Name:
Name:
Address: I
Address:
City: I
city:
Zip: Phone:
Zip: Phone: I
I
OWNER/ CONTRACTOR AFFIDVIT: Applicatidn is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commence 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.
Inconsideration of the granting of this requested permit, I do hereby agree that 1 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 concurrenry review: room additions,
accessory structures, swimming pools, fences, walls, igns, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Recor. . 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 9btain financing, consult with lender or an attorney before
commencine work or recordine your Nntir_e of rnmmPnrPmpnt_
3�&Wn �� d)L-u �
Signature of Owner/ Lesseetractor as Agent for
Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ._
STATE OF FLORIDA
COUNTY OF �d
COUNTY OF_pe1 I
The f oing instrument was acknowledged before I
e
The for Koing instrument was acknowledged before me
this; day of �/i�(A 6-, h . 20� by
this � day of fD rC-V) . 20JX by
Name of person making statement I
Name of pe on making statement
Personally Known OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
Type of Identification
Produced `API( GI1n%t 11 cr�lni�;{1
Produced 1�2tflnth I ItI
(Signature of Notary Pu ' - State cWlorida)
I
(Signature of Notary Publi - ate of Flori )
Commission No.
Commission No.
Pu�icSdbdi�iila
�tooSi09tt1751REVIEWSPLANS
N"WRZ
MY
VEGETATIO
�NMIYGl10YCI
REVIEW
REVIEW
REVIEW
REVIEW
DATE
441
RECEIVED
DATE
COMPLETED
Rev. 8/2/17 -