HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r1
Date: r o Permit Number: V S
SCANNED
BY REXORWom
St. Lucie County
Building Permit Application JUN 2 0 2018
Planning and Development Services
Building and Code Regulation Division Permitting De pa r
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial R side�tizWde C ntyr F�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION , � ',M ,. h; ' ' ,�,. `.`•° s '° `= F ;°,
Address: O /wa✓ .. „ , . ..... ... .,f.. .. ,
Legal Description: w l (y:bK J 6'I t l &_5X �4,-_ s-e,¢
Property Tax ID #: 4�J l l - G o Z. Z G / Lot No.
Site Plan Name:nn �e Block No.
Project Name:!°�d.�,o /-i/ L ealvrI./' 0l
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORKe ' 1 r
Spec S
CONSTRUCTION INFORMATION
under tnis permit -
E1HVAC FiGas Tank Gas Piping U Shutters H"Roof
ows/gnl�;f
11 Electric � Plumbing Sprinklers � Generator pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: �J b/
Cost of Construction: $ 2, Oa"� a Utilities: Sewer 11 Septic Building Height: /7- 5
01NNE�t/LESSf E
CONTRACTOR u
°d�o
Name e�7L �ay�
Address:/ o' C/ 11�g moo✓
City: 7�sr , de4s-4 State: A
Zip Code: L7z/g S7 Fax:
Name: c, 4 a �� �. S
Company:, s ���a��s ,46, l a�t✓ Q--�✓
Address: 3S./2S/
City: •�, C� Stater
Phone No.
Zip Code: c3�f �7 g v
Phone No.
Fax:
E-Mail:
E-Mail: Coe 4(An1/a1
LOs tcy 6
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License:
C6G 0-o3 S ,,:2
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,. , ..
SUPPLEMENTAL CONSTRUCTION LLEN LAW INFORMATION:
DESIGNER/ENGINEER: Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 -Ole bsite
before the first inspection. If you intend to obt in financing, consult with lender or an attor ore
commencing work or recording our Notice o ommencement.
71
0 "w rt t r ~` I„w`, --.ate•—
.
Signature of Owner/ Lessee/Contractor as Agent for Owner —
r ignature racto License Holder
STATE OF FLORID
COUNTY OFF"'
STATE OF FLORID�j /
COUNTY OF
The for oing instrugie�nt w s acknowledged before me
this �// day//of hzi �` , 20 /y by
The fo going instrument was acknowledged before me
this day of/�P� / , 20�" by
f � r� P�rvQ�'o'
1
i G
Name of person m�a mg statement
Name of person ma statement
Personally Known A/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. ;pro;"ti k�►f'XCi(�Sl�(�CHRAN
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N o ary u is -Slate of oridaCommission 8 GG 172136M
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PLANS
ANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17