HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE IN O MUST BE COMP LIETED FOR APPLICATION TO BE ACCEPTED
Date: L� 1� 1 Permit Number:' 611 dad$
SCANNED
FRECE—IVED—
AP�RBuilding Permit Application9 ?018Planning and Development Services
Building and Code Regulation Division nty, perm• is
2300 Virginia Avenue, Fort Pierce FL 34982 9
Phone: (772) 462-1553 Fax: (772) 46-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:.
Address: "7 Aje +-� l e S 101 C\ `--O k-
Legal Description:;, - -7 pJQ- C).,,�c%.e,e- e&'s
Property Tax ID #:
°o % Cl
Lot No.:7
Site Plan Name:
I
Block No.
Project Name:
Right Side: Left Side:
s C L�T�"'"' sd�c
'3'7 5 1 6
Setbacks Front Back:
,DETAILED QESCR'IPTION OF"WORK: - ;
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:,CONSTRUCTION INFORMATION.
Additional work to e nerformed under this permit -check a y app
❑HVAC 0 Gas Tank ❑Gas Piping Shutters ❑
Windows/Doors
i
❑ Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑
Roof Roof pitch
i
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
' I
0 ❑
Cost of Construction: $ 00, O CD Utilities: Sewer Septic Building
Height:
'OWNER/LESSEE _ ',,,,'CONTRACTOR
Name
Name: tSsfn,,`1eC P�
Company: T4. c br rd
:L & 3r.< 1Xk PLC
Address: 211 1 :?J:L_PhAAru' a AiuA C I V
Address: 1,`S�y� S1�
F�-k G.iiA%-i
City: State:
.--
Zip Code: `���( Fax:
City: r C
State:,(_
Phone No. �Sy p A ,. �( �{ Imo{
Zip Code: "%J C
'Fax:
E-Mail:
Phone No.
E-Mail: xj C pc I
� �q �{ , (•C-I i.-.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License:
If value of construction is $2500 or more,a. RECORDED Notice of Commencement is required.
T
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address:
City: State:
City: IState:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
I
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 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 arej 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
rnmmpnring work or recording your Notice of Commencement.
Signature of Contractor/License
Holder
Sigi ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
� "'4
STATE OF FLORIDA �)
COUNTY OF V��
COUNTY OF r'1n
The forgoing instrument was acknowledged' before me
The forgoing instr ent was acknowledged before me
this _ day of VN� \ 1203 by
this a_ day of
20A by
Name of person making statement'
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR
Produced Identification
Type of Identification
Type of Ident'ication�^
Produced '�� �] - ) k! I
ProducedT�
(Signature of Ulm'. plwido
(Signature of Notary
-
tate of Florida )
CAROL A. PREW
Commission No. Publl(§tA of Flodda
RENotdry
Commission No.
v a� �� CA Lb PREW
" ry to of Florida
Commission# FF 149300
omm, expires Aug, 10, 2010
Commission# FF 149300
hV 091flfft: e4me Aug. 19, 8018
REVIEWS
FRONT
ZONING'
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
?�f�J
RECEIVED
DATE
COMPLETED
Rev. 8/2/17