HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,J
ALL APPLICABLE 1NF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Nu `'b d A
�—
RECEIVED
BY
St Lucie COUntY
Building Permit Applicati APR 3 0 2018
Planning and Development Services• Lucie County, Permitting
Building and Code Regulation Division
23DD ,Virginia Avenue, Fort Pierce FL 3.4982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: _%D� CO6`"t�C`Z ?j)00
Legal Description: e Cri ea -�'d� c T ��Q��- i 5�� ��y✓
Property Tax ID #: c)'z/d > • i'60 • Co0a - 000i • O Lot No.
Site Plan Name: Block No. o�
PX-oject Jyeme;
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
('-en`�t fix.-s-Sr::.S SIr..�1-c � o.n�r7 sz�lacY (.�•-� � l' m�-E-� c��'
i
CONSTRUCTION=INFORMATION•
Additional work to be nertormed
11HVAC
un
Gas Tank
er t is permit - check
❑Gas Piping
a
apply:
❑
_Shutters
Windows/Doors
ClElectiric Plumbing
0�prinklers
0,Gener-ator
2--Roof MI Roof pitch
Total Sq. Ft of Construction: C��iCJO
S . Ft. of First Floor:
%�
Cost of Construction: $ 49 �Sc�
Utilities:]
Sewer
Septic Building Height: /4
OWNER/LESSEE:,
CONTRACTOR:
Name NA tic M
Name:
Address: r�763 t�r-�-tz 13(0�,
Company: -�-btoo (';,.e CA
,City: %� 1 �� crc--c State: Yl,
Address: 116 AtZip
Code: �y�/�'� Fax:-
City: `*0C"r-V State••
Phone No.
Zip Code: 944 9,5- Fax:
E-Mai1:1T%Yci % 9 CC %&v . Carl
Phone No. 729- �3.3, �-'39 6 '
Fill in fee simple Title Holder on next page ( if different
E-Mail: f'6raaC6�ctno' bu. �2; ^a 00 ComcosI-- ncl�
from the Owner listed above)
State or County License: LAG o- i 7(o
11 vewe or fonszructIon is azsuu or more, a KtGUKUtu notice of commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
DESIGNER/ENGINEER: _ Not.Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
i
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in zonfli.ct with any appficable Home.Owners Association rules, bylaws.or anal .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 recordine vour Notice of Commencement_
4
1 0o
)n
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Li .
STATE OF FLORIDA
15
_
STATE OF FLORID
COUNTY OF I i L. U t P
COUNTY OF •�, • Lo c
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 'Q_? L,day.of _ i➢ i 2o1 bar
this c2io- day of ' l za-a by
9112 kitm
1b6C.r 47- L004 �
Name of person making statement
Name of person making statement
Personally Known r/ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
/AL
O�
(Signature of Notary Pu ..'
(Signature of Notary Public- State of Florida
�+ rK+ ocy Notary pp��O_ilq�State of Florida
Commission No. `i - Lisa mmley
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Commission No. INAIP � Nqt�pl��pIicStetedFlorida
i✓�Svmley
p 4 • My Conilnisslon GG 087766
Expires 04/29/2021
Lf�a
c My Commission GG 087766
4, Expires 04/29/2021
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DATE
,RECEIVED
DATE
COMPLETED
Rev. 8/2/17