HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CCSMPLETED FOR APPLICATION TO BE ACCEPTED �Q
Date: (D - �� ) Permit Number: • � ST
'RECEIVED
Building Permit ApplicationLR.E
JUN 2 0 2018
Planning and Development Services mittinBuilding and Code Regulation Division g Department
2300 Virginia Avenue, Fort Pierce FL 34982 LUCie OUntyr FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ReI
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line e"k
rWrv, a�uAr�ufrK.t1;1/rt1ItNl' LU(Af:CUN:.
Address: 0 GXneer, Cp k4_pc=,M ?(01iig F3363
Legal Description:
Property Tax ID #:
Lot No.
Site Plan Name: WOrser Block No.
Project Name: �.'KeCW,CkA%
Setbacks Front,_ Back: _ AJ Right Side: _j O,_ Left Side: )LJ�
JUILRJI 101 VVV(R LV LJ I" �''uiurmea unaer tnis permit— cne
0HVAC Gas Tank ❑Gas Piping0 ,
Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:; SQp. 00
Cost of Construction: $ )0,cctr� vo
Shutters Windows/Doors
Generator Roof
S . Ft. of First Floor: _
Utilities:i Sewer E]Septic
Name �,,�;\\soM Leber
Address: N30 Queen
;," State: FG
Zip Code: 2LrIL A- 6363 Fax:_ lJ%A
Phone No.-1-7a.' 65S r
E-Mail: A11A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
'C0NTRACTO:R:
Building Height:
Roof pitch
Name: Mcm(t_.
Company: G , S , kAccxe
Address: 2\6 Eclat-b�- ►7-
City: arc, ` er<�, State: FL_
Zip Code: 32;Lg(Q Fax:3q4-
Phone No.-l-7X- 643- 166-
E-Mail: -ts P &_A1Cc,Si .r)F�
State or County License: OC- \3006I aD_
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
� S'U�PPLE{UIEN�AL�:C'®NSTRUCTfON :Lf�EN � .'; ."1iNFQR�MATIO�N�
DESIGNER/ENGINEER:
_Not Applicable
MORTGAGE COMPANY: , Not Applicable
Name:
_
Name•
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
VYYIYCK/ 16 IV I KALI UK AFFlDVIT: 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 your Notice of Commencement.
Signature of 0 er/ Lessee/Contractor as Agent for Owner
fvi�
.d.
Signature of Cont ctor/License Holder
STATE OF FLORIDA STATE OF FL
COUNTY OF Yl V R \ftr COUNTY OF DA QY Q r LUX —IN
The forgoing instrument was acknowledged before me The f rgoing instrument was acknowledged before me
AT —
this � day of :1'I�)3 2 20� by this day of Z�l_V\ Q, 201% by
rwe'Q V1 CAGC
Name of person making statement
Personally Known 7 OR Produced Identification
Type of Identification
O'� ic
(Signature of Notary Pub c- e�of 131 1>fa E P. 2IMfV1ERMAN
,State of Florida -Notary Public
Commission No. l`710 Con(gg�gg on GG 141634
My Commission Expires
September 09, 2021
REVIEWS FRONT --, I ZONING SUPERVISOR
COUNTER I REVIEW I REVIEW
FATE
Rev. 8/2/17
Name clf person making statement
Personally Known �_ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public -State Ya) DANIELLE P. ZIMMI
r.State of Florida-Notai
Commission No. CommissionGG 1
' a0y Commission E:
September 09, 2
PLANS I VEGETATION I SEA TURTLE I MANGROVE
EVIEW REVIEW REVIEW REVIEW
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