HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED
Date:
Build
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:. (772) 462-1553 Fax: (772) 462-1578
APPLICATION TO BE ACCEPTED
Permit Number: / �� l7
9p
�'.itApplicatio MAY 0 8 2018
Permitting Dep rtment
mmercial . Lu ie o nty, FL
PERMIT APPLICATION FOR: To Select fromldropbox, click arrow at the end of line
"PROPOSED IMPROVEMENT LOCATION: j
Address: �O�O 1 GC Ce
Legal Description: S Q CJO _ T °� 3
t,,1 Cr to 1-t' - LA t, Cv' 11C �(1b Ron
Cc n �- 1 \ , s It �' l� S
Property Tax ID#: IL\C;`3-Sd��lljrc�zk)-i1ab'C6 Lot No.
Site Plan Name: J�K�/ 1 Block No.
Project Name: 4;z'k�'A t\_1r\1zXA1
Setbacks Front Back: \F) — Right Side: Left Side:
DETAILED .DESCRIPTION_OF WORK:_
. .
ma-r, ,L 9AIC10-" b 16X2.5X IO b&7'gCKE, !}CCES6oQY S7R1JC UP_L= 0A1 -Qs/
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CONSTRUCTION INFORMATION:
A�dmonalworKtobenerformedunder this permit -check all tbiit apply:
❑HVAC LJ Gas Tank []Gas Piping 1 Shutters ❑Windows/Doors
❑ Electric ❑ Plumbing []Sprinklers ❑ enerator ® Roof 3 12- Roof pitch
Total Sq. Ft of Construction: 3�`� S . Ft. c
Cost of Construction: $ �nd Utilities:n S
rst Floor: _
RE Septic
Building Height: ioC
'70WNER/LESSEE: 6' ',CONTRACTOR:
'
Name .ego
Name: C1,1� MES
Address: 1 { `
Company: lc"wopn !q-1V YUJHERi-
Address: P6, fBoX 774
City: State: U
City: �T��'-kC State: ��-
Zip Code:' Fax:
Phone No '1-\ r;\Q� ^ 3ut4
Zip Code: 3� 091 Fax: C35z�46 5-1113
E-Mail: '- O Ch h v)
Phone No. l'135246S '0/(6
-�
Fill in fee simple Title Holder on next page ( if different
E-Mail: ` pern4fSYa/P qh72f1 44Pn
from the Owner listed above)
State or County License: c8C[o15"1�J9�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is
SUPPLEMENTAL CONSTRUCTION
1113`I LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: i3ECXTbL Enl�J1\Ify!5 T'Es�'!/�
Address: 6O5 W /VEXI yoR.f< 4yF—AWC—�
City: bQ-gAlo State? FL.
Zip: 2-720 Phone
I
FEE SIMPLE TITLE HOLDER:. _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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 grantin�' 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 Buildin� Codes and St. Lucie County Amendments.
The following building permit applications are exempt fro'undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a No�creen
ce 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 recording vour Notice of Commencement.
re of Own
STATE OF FLORIDA
COUNTY OF
/ � I
ctor as Agent for Owner Signature ontractor/License Holder
LI `�� I STATE OF FLORIDA
A_C_1LCOUNTY OF 8R4-bF0RD
The forgoing inst me t was a "knowledged efore me
this day of 20 by
Name of person making statement I
Personally Known 1,� OR Produced Identification
Type of Idept9kcation
Produced
(Sig ry ubl c-
iiL
Commission No. '1 MD #G�G179129
`bia� a EXPIRES: March 23, 2022
The forgoing instrument was acknowledged before me
this 30 day of A' Pi21 L 20 18 by
J HA4E6 PLAY
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signature of Notary re
.
Notary Public State of Florida'.ommission No. Maria R B�
My Commission 9.12775
Oa �� Expires 08/26/2019 • I. . .
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OMPLETED
Rev. 8/2/17