HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONk
ALL APPLICABLE INFO MUST BE COMPLETED FOR
Date: 5 �3 S6A
CATION TO BE ACCEPTED
Permit Number:
`s FRECEIVED
St Lucia GOV
Building Permit Application 3 2018Planning and Development ServicesBuilding and Code Regulation Division nty, Parmitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Generator I
E,
PROPOSED IMPROVEMENT LOCATION:., '
Address: 1 S0 ` NW
Legal Description: "r
Property Tax ID
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WO1
2,1 V,0, i.J .51v, +
Z-,A•G 4 v}u bid n
flo , u �e5
13 �w�i-�1�s�, VJi" a
Lot No.
I Block No.
Right Side: Left Side:
CONSTRUCTION INFORMATION:,.,
Additional work to be Dertormed under this permit- check all apply:
0HVAC Gas Tank []Gas Piping 9-Generator
Shutte Windows/Doors
.lectric PlumbingSprinklers Roof I� Roof pitch
Total Sq. Ft of Construction: 5 . Ft. of First Floor:
Cost of Construction: $ 34;6 .00 Utilities: U Sewer Septic Building Height:
I
OWNER/LESSEE:
CONTRACTOR:
Name RfS 'r Fir%neL" i
Address: I aisk C.1 v-
Name: i 'e �1�ti XAr1
Company: e-Is
Address: .Z 2 B( VGt
�.
v
City: p 1M LiStater
Zip Code: 3!tQ Fax: I
Phone No. gL i` LOB
E-Mail: Fin P TBSW P 000tm
Fill in fee simple Title Holder onineut page ( if different
from the Owner listed above)
,-+
City: State:_tLl
Zip Code: 3�g�� Fax: 7%2�.3��'Golo72
Phone No.
E-Mail: ,Gi 4ehtiec,; . 40'
State or County License: ec, ).3todG4 i
IIf value of construction is $2500 � more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW; INFORMATION:
DESIGNER/ENGINEER: Not Applicable)
Name:
Address:
City: State: I
Zip: Phone I
I
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
City: I
Zip: Phone: I
I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is herleby 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 alpermit 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, Ildo 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 frolic 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 Nlotice 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 cy- recording v-eVNotice of Commencement.
I
Signature of Owrkr essee/Contractor as Agent for Owner
Signature of Co rac or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF • LLV— t Cb ,
COUNTY OF S!- 1AAX A-9 C.
The for oing instrument was acknowledged before m I
The forgoing instrument was acknowledged before me
this 1% day of � ft 20 (I by
this Lib day of M 0►i 20a by
Tc�die I F� AX 141aN
1 �c6►a�.l IlockI!N,i
Name of person aking statement I
Name of perso aking statement
VOR
Personally Known OR Produced Identificatio
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur
(Signature
^ �avr Notary Public State of F rid
CommssSoo If CHRISTINE MARIE CILL i
�+ Notary Public State of Florida
Commission CHRISTINE MARIE 4 �LL
S cz < < My Commission GG 154932
�+a,n0P Expires 10/25/2021
i
.y My Commission GG 5493
�j��p� Expires 10/25/2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17 I