HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE (INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C'(
Date: I Permit Number:
r �6CJ iiSCANNED
BY
RECEIVED
SQ pie ,, �/
Building Perim�11 p�Rication MAY 2 9 2018
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: &-mod
PROPOSED IMPROVEMENT LOCATION:
Address: 1 ( �1 [) cmw
Legal Description: Vua k .Ir 1(�Il�,i l' �Oa
a� Go\P c-
Property Tax ID #:
Site -Plan Name:t`J t;A�
Project Name:
ST. Lucie County, ptrmltti
Commercial Residential
-►ovA- s`�'(la- "'n r in(IG
?i Lot No.
Block No.
Setbacks Front Back: Right Side:l Left Side:
11
DETAILED DESCRIPTION OF WORK:
I n5�t e,�Q fit) ;D� 1 1 �v ct �
nn�e e- � ncc Sc� 1� ►�e Icx.A
[CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit— c ec a apply:
11HVAC E] Gas Tank ❑Gas Piping hutters ❑ Windows/Doors
13 Electric ❑ Plumbing Sprinklers gGenerator E]Roof Roof pitch
Total Sq. Ft of Construction: , S Ft. of First Floor:
Cost of Construction: $"t Utilities, : Sewer El Septic Building Height:
OWNERAESSEE:
`CONTRACTOR:
Name K k Lhc._
Address: I C_)'__1 C� t N CkN[\jCiM4hj
!Name: n l
mpany:
Address:
i
City: c
1
Zip Code: ,
"E-Mail: Phone No.
E-Mail: P_
``
�1((J
I� ((St�na/ter
F60
City: CJ fv-\ 0 It State: (
Zip Code: J�{�C(C� Fax: "
Q
Phone No. � � �— o-ic7o�,b
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
i
State or County License:
_���itr9
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
I
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
I
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 tot a 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 a Notice' 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 finlancing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of
STATE OF FLORIDA
COUNTY OF
ntractor as Agent for Owner
The forgoing instrument was acknowledged before me
this day of IIk4l 20J-t by
Name of person making statement
Personally Known OR Produced Identification
Type of Identificatio
Produced
(Signature of
;fir► Commissio NICHOLE AP((s®NIE
[iSS10N #03031
RF EXPIRES May 04, 2020
REVIEWS
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
FRONT I ZONING I SUPERVIS
COUNTER I REVIEW I REVIEW
Signature of Confraftor/Licens'e Holder
STATE OF FLORIDA
COUNTY OF '-. LuG1,C
The forgoing instrument was acknowledged before me
this a_7 day of May , 20 11 by
04tCJACL 1 RCtYW�
Name of pe son making statement
Personally Known T OR Produced Identification
Type of Identification
(Signature of Notar Public- State of FI
;' Ye ;, NICHOLE APONTE
Commission No. ' Y COMMI�BN # FF9So3031
s:°c' EXPIRES May 04, 2020
PLANS I
REVIEW V EVIEEGETWON ' SEA REV EWLE I MANGROVE