HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSALL APPLICABLE (INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: J ���
Permit Number:
SCANNED RECEIVED
BY
Building Per-mitA&MAtion MAY 0 3 2018
Planning and Development Services
Building and Code Regulation Division
ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
Residential
PERMIT APPLICATION FOR: To Select f om dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Z - Q(_Wk ?-A -P? i ✓—"--
Legal Description: W/,Vp k?/r-G (%IGLAC-,E f�iY %f 51e�+ - ✓,t/ / % 71—W11
l7- �o
Property Tax ID #: 4752L $/i - 000 7 - 000 - O
Lot No._�
Site Plan Name: _ I
Block No.
Project Name: L'-LKLC /4-
Setbacks Front Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
14 F7'1�c
E e--Cf- � L
CONSTRUCTION INFORMATION:
Additional work to be nertormed un ert is ermit - check
1]HVAC L Gas Tank as Piping
a11 apply:
Shutters a Windows/Doors
_I
_
L_I Electric Plumbing Sprinklers
a Generator E]Roof Roof pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
El
Cost of Construction: $ Utilities:
Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name RAvL 3t -D/R2✓E 15�CIAJ
Name
Company: 7e6as"Xa
Address: 4Z % a ua- )2 - ''t ✓- J
City: JINS E1/ geAc4a_ - I State: L
Address: /Z D 0 6-;9
Zip Code: 54� 7 Fax: I
City: Si"7-4-9-7r- State-
Phone No. Jr /- 144# - &1913 I
Zip Code: 3`f FSC y Fax: Z 2/ - l b 11
E-Mail: C,41Z a ZZ /Z I' 8& Sw s0 2�7`
Phone No. 772 - Za/ - 97-17
,
Fill in fee simple Title Holder on next page. f if different
,/
E-Mail: Tr�S�/���ft-sT �" rfYl , Cv K1
State or County License: Z 0 0 77
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: Blot L 1/JG6,C14
_
Name:
Address:/ �3
Address:
City: Ta2'T d ; e-E State: 11%—
City: State:
Zip: Phone ?72 -7Fr5 =
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applic ble
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 pr or to the issuance of a permit.
rantir'j St. Lucie County makes no representation that is gg a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners AF,soclation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Assotlation 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 Buil�I6ing 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 I Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of ommencement must be recorded and posted on the jobsite
before the first inspection. If you intend to o tain financing, consult with lender or an attorney before
commencing work or recording our Notice o Commencement.
bil
n rr essee/ ontractor as Agent for Owner
Signature ofF�0111
Sig ture of Contractor/License Holder
`
STATE OF DA ` I
COUNTY OF �� ��
STATE OF FLORID/J n�Q
COUNTY OF 1! ►((�C.IC�GGt,
The forgoing instrument w .s acknowledged before a
this _(Qday of 20 by
The instru nt was acknowledgefore me
thi y of 20 by
Name of person making sta ment /
Personally Known OR Produced Identificat on t/
Name of person m king statement
Personally Known OR Produced Identification
Type of Identific ion -
Produced
Type of Identification
Produced
(Signature of Notary P lice p ,of FloridWHE C.1t00RIGUEZ
4"A e`�•,,
+ Mytu P�blic Slate o1 F10tid
Commission No. : - j�� Expires May �. Z018
Commission N FF I J 91.27
Signature of tary u li
b �o ,; LUCYJULIANO
/ j 1 =. tyblic _ State of Florida
mmission No. l�'� `- Y&P
Commission # GG 101693
y sac My Comm. Expires Aug 30, 2021
.. &rdedthrough NationalAotaryAssr,
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S%t (tom
Rev.8/2/17