HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED
Date:
�UANNED
UN �Y
t Lurie 00ty
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
Af %101 N TO BE ACCEPTED
MAY 2 Y 1018 ' Permit Number: _
hitting pe
t. Lucie C?untY
g Permit Application
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION::
Address: 96�
Legal Description: —tAtoy w 9141 s Sib C7!JaSu�rr C 10g L4-L7L.oT SA na- .390-_t11V
Property Tax ID #: & Z S3 66 G
Site Plan Name: InST.dle Zv
Project Name: 62<-M W7e�
Setbacks Front Back:
Side: Left Side:
DETAILED DESCRIPTION OF WORK:
/Z k,?% Ali wimv.w Actst,srQAlR/a/oj-`
Lot No.
Block No.
CONSTRUCTION INFORMATION-
ACIditional work to be ertormed under this permit -1check all apply:
EIHVAC Gas Tank ❑Gas Piping fin _ Shutters Q Windows/Doors
Electric 0 Plumbing OSprinklel s E Generator F]Roof Roof pitch
Total Sq. Ft of Construction: ZS y S . Ft. of First Floor:
Cost of Construction: $ Zy ;O UI ilities. Sewer E]Septic Building Height:
OWNER/LESSEE: i
CONTRACTOR:
Name T .t.I Zo
Name:
Address: �d T D� JQrs DA - T
Company: LG'S L�D�/'f2aGT�r, �GdJeG U-c—
City: r*f OtAce State:A! L�
Address: 222<- 11QVu&1Zabee
Zip Code:, �fQs/T— Fax: I
City: AyAAb&A= State
Phone No. MC1 % i
Zip Code: _ge4<0 Fax:
E-Mail: I/��� I
Phone No: 32i-?f� Az!C7
Fill in fee simple Title Holder on next page (if different
E-Mail: J✓/b,2, Ja.. At S P_ he rwA i /. ea,Yt
from the Owner listed above) II
State or County License: iG e- �C/6/,66
If value of construction is $2500 or more, a RECORDED Notice'of Commencement is required.
* =2
SUPPLEMENTAL
Name: 4
Address:
City: Jwi is
Zip: � /D Phone-4
FEE SIMPLE TITLE HOLDER:
ICTION LIEN LAW INFORMATION:
Not Applicable MORTGAGE COMPANY: NW Applicable
vdnAme 0640Name:
Address:
State: y City: State:
/ _ 27/� /M►�,/ Zip: Phone:
_,,NetlApplicable BONDING COMPANY: -L_No t Applicable
Name:~
T Address:
I City: { City:
i Zip: _ Phone: I Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applic tion 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 Count makes no representation that islgranting a permit will authorize the permit holder to build the subject structure
which Is in con Ict with any applicable Home OvJ�ers Association rules, bylaws grand 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.
Inconsideration of the granting of this requeste permit. I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Flori IIa Building Codes and St. Lucie County Amendments.
The following building permit applications are ez@mpt 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 Notices of Commencement must be recorded and posted on the jobsite
before th r inspection. If you intend to obtain financing, consultyv* h lender or an attorney before
commeatiniz work or recordine vour Notice of Commencement.
Si ure of Aei/ Lessee/Contractor# Agen fotOwrr 4 SigTiai'ure of Condor/license Holder
! STATE OF FLORI (/ `I STATE OF FLORIDAII
COUNTY OF�+P.c COUNTY OF___�^—�_
The for Ding instru ent was acknowledged bef Ire me The for Ding instru ent w s acknowledged iefore me
this f day of 201e by ;this day uF t 20 — by
I
Sle_n�13cEY.i��Q ; -S���n '/
Name of person making statement �� Name of perso aking statement
Personally Known OR Produced Identificati' on ..,L/ i Personally Known OR Produced Identification --._
Type of Identification 1 Type of Identification
Produced 1 Produced _
(Signature of — ' cure of Mot Public- State ofFlorida
Commission It'
-M$TQ�MIEFII LEE POW S ission No,
MY COMMIssl�ni dE1=1=1 i�d9 °` 'Ir`�s'4 CIiRISTOPHER l
REVIEWS I f407ka"53 ZOWWJdallojJ$(Filflh�S�Jt�1 PLANS// VEGETATI
—'Zi7i71 r trfc�0��"l—"RLiCtC�IS�h�RLifL I REVIEW
COMPLETED j— — ( IpC Jf qI
Rev. 812117
8, 2018