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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR i. Date: �•�; ;; gpp\fF W-11001- 00'', Sthider 1, J. dis. - ME Building Planning and 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 PROPOSEDD-IIVIPROVEM.ENT LOCATION: Address• LS Legal Description: Ar Property Tax ID #: —l�l' -;) (0 VA Site Plan Name: -i a n i'i 1 go- M61na Project Name: Setbacks Front_U Back: - I!L Right DETAILED DESCRIPTIOU OP WORK:- Wide hovae- ON TO BE ACCEPTED Permit Number: �ari 1 0 0 z �RECEIVED it Application MAR 3 0 2018 permitting Department t. ude County ►rcial Residential dropbox;,-click arrow at the end of line © Q i q - 0 oc--) I c Lot No.%- 1n rN1 a Khc Block No. —I,!Z_ Left Side: IT r- ?oi v c mpi c n CONSTRUCTION INFORMATION' - Additional Iona worK to be nertormed under this permit- c eck all app : �HVAC 0 Gas Tank ❑Gas Piping _ Shutters Windows/Doors Electric Plumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: I6 9'9 Cost of Construction: $ S-06 Utilities: Sewer H Septic Building Height: P I OINNt LESSEE: �.. CONTRACTOR: Name eot-krA l i�fStJi? mfloN ilfMP_ i(P_Q Name: Q� ` Address: Li 1 JLS- ` Company: Ghlite Wi ek_T�G City: k c 211ce� State: ]0L Address:.P 100k $ Zip Code: Fax: City: Cmate_ Stater Phone No. 717 - ZS_X- Ci399 Zip Code: 0339vCl Fax: 9613 `096_026 E-Mail: Phone No.�� Fill in fee simple Title Holder on next page ( if different E-Mail: S from the Owner listed above) State or County License: 3 b 63 C-) If value of construction is $Z500 or more, a RECORDED Notice of Commencement is required. 1 :SUPPLEMENTAL CONSTRUCTION LIEN_.L# INFORMATION: DESIGNER/ENGINEER: XNRApplicabl Name: Address: I City: State: I Zip: Phone MORTGAGE COMPANY: Not Applicable Name: Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Appiicabl Name: Address: City: Zip: Phone: BONDING COMPANY: Not Applicable Name: Address: City: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is her by made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior t the issuance of a permit. St. Lucie County makes no representation that is granting a ermit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Assoct tion rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Associatio and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I d hereby agree that 1 will, in all respects, perform the work in accordance with the approved plans, the Florida Building odes and St Lucie County Amendments. The following building permit applications are exempt from ndergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, walls, signs, sc een rooms and accessory uses to another non-residential use WARNING TO OWNER: Your failure to Record a Notre 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 Onancing, consult with lender or an attorney before commencing work or recordine vour Notice of Commencement. l Dun �c � ��aw' Signature of Owner/ Lessee/Contractor as Agent for Owner . Signature of Contractor/License Holder STATE OF FLORIDA . STATE OF FLORIDA COUNTY OF COUNTY OF_ Q) '11A The f oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 1/i'�(A 6`1 .20 by this day of MO IrCI(1 .20A by 1 lancem Name of person making statement _6mn Name of pe on making statement Personally Known 7OR Produced Identification Personally Known A OR Produced Identification Type of Identification' Type of Identification Producedc r<F)g2 ^n I I c� r() �t1ac a Produced 1)e_r_Vl Rrn 1 illIL (Signature o Notary Publi - ate of Flori ) (Signature of Notary Pu ' - State lodda) Commission No. Commission No. 04 Notary Public Seats of Florida _ cf Rim da Lon +F Victoria Lauus • • REVIEWS M MY res o�ta2 PLANS VEGETATIO C WRIM11M REVIEW REVIEW REVIEW REVIEW DATE RECEIVED � I((:; DATE COMPLETED Rev. 8/2/17