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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBy - ALL APPLICABLE rFO MUSTIVED BE MPE�FOR APPLIC- @ O BE ACCEPTEDf,�`�OG r�JMDate: (<, t Permit Numb r: / 5 �/ 0 Lzy; LU wn Lq5-: J, ri I =_1 1 itding'Permit Applications JUN 112018 Planning and Development Services Permitting �e artmen .Building and Code Regulation Division g p 2300 Virginia Avenue, Fort Pierce FL 34982 St. L Cle L l n ty, FL Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial esident PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: rJ I OZPa vv..o Leg I Pe cription lv �rtt G�^ / Z S D� OCJ�ja lsr T� a .7 PropertyTax ID#: V Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: Go.s��� +�-c. rx�r sy ski-•-� , !.� u�' � r� bu�i�.� �jci s�`� VN\\ I D h CONSTRUCTION INFORMATION: Additional work to be nertormed under this permit -check all apply: HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors Electric Plumbing Sprinklers Q Generator a Roof Roof pitch Total Sq. Ft of Construction: S . Ft. of First Floor: Cost of Construction: $ �00_1 000 Utilities: Sewer L� Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Address: S l0Z T \w.�, ►°r�� Company:�-- Address: City: V r_k eJ6-e_ State: Zip Code: 3q,119 Z- Fax: AJ e•4 Phone No. City: 'r Zip Code:.3 Liq9 q Phone No. -7 L - E-Mail:, State: �L Fax: 7 ? Z -LIZ-0 b —,37ell —Le— Cd4PADa n 1L , E-Mail: �1SJ A- Fill in fee simple Title Holder on next page ( if different from the Owner listed above) State or ounty License:CCsC I SI �f 113 IIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required. II m SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name:J o,22�V. _ Name: Address: Address: ou C7 dsGe—oe., City: State: City: State: Zip: 3 tl,1 -rq Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: 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 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 financing, consult with lender or an attorney before commencing work or recording vour Notice of Commencement. I ' i Signaturef Owner/ Lessee/Contractor as Agent for Ci ner ontract r�lLicense H Ide ignat=LOTDA, STAT FLORIDA STACOUNTY OF '5+ �uc�e COUNTY OFp� f The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me —,% this day of u� 20� by this day of P_ 201Z by cJGr. 1114 i PJ Q/' 9Lo Name of perso pakingRaatement IName of person making statement Personally Known t,,' OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of I entification Produced Produ d C. RnRERTS (Signature o tic-P`�hyly 8fi�iloradda a of Florida j Signature o N tary Public- State of Florida I�A mella A. Schoonover _ :° w •= Commission FF 221708,2� l�1ARY,�so ARY PUBLIC Commission ; or��r�e N oft:' PAy Comm. Expirgd�;r iC, 2019 ` Commissi o. E Bonded through National Notary Assn. A ' OF FLORIDA � a Comm# FF931908 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED i DATE COMPLETED tev.8/2/17