HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1W
ALL APPLICABLE INFO MUST BE COMPLETED FOR
Date:
Bul Ude
Aing
ON TO BE ACCEPTED f
Permit Number:
101
mit Applicati
Planning and Development Services I
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 l Commercial
PERMIT APPLICATION FOR: To Select f
PROPOSED IMPROVEMENT LOCATION:
Address: TA KAO-"na T)I?AV-e, �ta►/�
Legal Description: emo I 0-bye BP1 J N -tf
PropertyTax ID #:
Site Plan Name:
Project Name: 9�2 I�OV.�C�cl
Setbacks Front Back:
MIX
RECEIVED
MAY 2 2 2018
STD Wod C@wnty; PermI ting
Residential
dropbox, click arrow at the end of line
ht Side: . Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit —check
D ❑Gas Piping
all
apply:
Shutters
❑ Windows/Doors
AC
Gas Tank
_
_
Electric 0 Plumbing ❑Sprinklers.
❑ Generator
❑ Roof
Roof pitch
Total Sq. Ft of Construction: I S . Ft. of First Floor:
I ❑Septic
Cost of Construction: $ utilities.
i
Building Height:
OWNER/LESSEE:
CONTRACTOR:
" .
Name
Name: [ I
Address: Xn �4,a rlly bP, i
Ord�City: ,l_
Zip Code: Fax:
Phone N 7M (A ` J5_M I
E-Mail:
Company:
�d
City: 6rhA State: f�
Zip Code: 3olZO 2-Fax:
Phone No. _
E-Mail: as COY)-7
Fill in fee simple Title Holder on next page ( if different
fromthe Owner listed above)
//a
State or County License: �C�3�Qcf1�snC(�
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:
Name:
Address: I
Address:
City: State: I
City:' State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
I
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 permitir 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, sig I s,.screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a NNotice 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 obain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for
STATE OF FLOR!1 _ [ � iR
COUNTY OF ..__I_r 1Q �y�__�_l
The go _ ing instru nt was acknowledg d before
this � day of 20_M by
r--*, i r
Name of perso making statement
Personally Known_ OR Produced Identifi
Type of Identification
Produced
ner Signature of Contractor
STATE OF FLORIDA
COUNTY OF 0"
The forgoing instr
this day of_
OArC' � �
Name of
Personally Known
Type of Identifical
Produced
(Signature of Notary P blir�' �1 of Florida ' I (Sig,
a�., SAN 1 MARKOWSKI
Commission No. = Notaiyfgl State of Florida Com
`?�` My Comm. Expires IJan 3, 2019
i Commission # IF 166216
REVIEWS FRONT ZONING I RVS
I COUNTER REVIEW I S REVIEW
icense Holder
vas a nowledged before me
2011 by
making statement
_ OR Produced Identification
of Notary Public-%tatkof Florida )
No. 26
T v�puda
bll� bf Flori
rira -Made McCurdy
wi My Commisalon GG 112270
; Fxolror<0810812021
REVIEW NS I VEGETATIEV EWON I SEEV EWLE I M EVIEWVE
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17 i
SUPPLEMENTAL C-10 TRU&I N LlbNIW INFORMATION
eA
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone I
I
City: State:
Zip: Phone:
'
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:. Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application isJhereby 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 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 al Notice of,Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and po$ted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement. /
Signature of Owner/ Lessee/Contractor as Agent for
Owner
Signature o Contractor/License Ha
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF 'IMAGa
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
this 23rd day of APRIL 20IB_ by
I
NICK ARMSTRONG
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
IrnRARAI
ANA MELISSAIAL BEN'rSTAMP
FAR
NOTARYPUBUC-Oq GO
(Signature of Notary Public- State of Florida)
(Signature of Notary PublS 1
FEBRUARY 13,
Commission No. (Seal)
I
Commission No. 958451 (Seal)
,
REVIEWS
FRONT
ZONING
I
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17