HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONu
APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O
te: 6 1 BY Permit Nu
St. Lucie C®un%fI WMICEIVE
Building Permit Application JUL 2 0 2018
Pi
B inning and Development Services Permitting Department
lding and Code Regulation Division
23, 0 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County FL
P ''one: (772) 462-1553 Fax: (772) 462-1578 Commercial
PE�'I,MITAPPLICATION FOR:
PR POSED IMPROVEMENT LOCATION:
Add li ss: GiLljo JC�1r�0� ��,N` ("I i
Lega�� Description: ` c� 12 3 13 YVD1 xTr 'T4-F•t= �_ 1P 1yf-'
i I Fj- 2 ( -
Prop 11 rty Tax ID #: � - c � �C"�a('��7 - WO - 3 Lot No.�_
Site an Name: Block No.
i
Proj 'ct Name:
Setb I cks Front Back:���ltight Side: • Left Side:
DET ILED DESCRIPTION OF,WORK: ,^, r�
r X J I �� �1�rll ll� �C r2t=� h l � ) L F.. MC L-C) SC.,�� LMCXI/ POOL
rj,,/— r'2?e i2 rvi : 4
jqL?)- Da -I,-;
CONSTRUCTION INFORMATION:
j I onal work to je ne orme under this permit- check a apply:
HVAC lJ Gas Tank ❑Gas Piping _ Shutters E]Windows/Doors
Electric ElPlumbing Sprinklers F]Generator EIRoof Roof pitch
Total Sq. Ft of Construction: `i �16 S Ft. of First Floor:
Cost olF Construction: $ c� C((� . Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namellb, , 1 J.
Name:
SC_i4jAQE
Andre, s:CICI0 `XA�I",(
City: 1 — S,T . L_A2r I - State:
Zip C 'de: SLA cl rStra Fax:
Phone I'No.
Company: I` 3 J l htl7l�`i" Ga I E
Address: G'A 5%jv 15101-io ZP_ ST .
City: f �e: .5 • Lk-)C.t
Zip Code: �Li�G��J
Phone NCo/.-`! ! iv�L '
E State: 'NL.
Fax: 17,7c) 5 7C1 - (mil®
Ck - (� S l -
E-Mai is
Fill in iJ a simple Title Holder on next page (if different
from de Owner listed above)
E-Mail: t-imD3 &lD(c�
A L.-: C; �'
State or County License:
If value Of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S
` PPLEME
ONSTRUCTION LIEN LAW INFORMATION:
D'I
N
A,
Ci
Zi'
'
SIGNE ENGINEER:
l
_ Not Applicable
V iCw
MORTGAGE COMPANY: _ Not Applicable
,rName:
Address:
dress•L4`IQ %a fa it ` irm .g lam. 04,-T lol
y: c� Ir1�IiZk1 i Li S . State: t
`�;;FiLIQ Phone �i3�, -7c6'?S - E81U
Id
City: State:
Zip: Phone:
FOE SIMPLE TITLE HOLDER:
it
N me:
Address:
Ci
Zip: Phone:
III
Not Applicable
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 ce lfy that no work or installation has commenced prior to the issuance of a permit.
St. Icie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whi h is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
stru Pure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
II
in co psideration 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 fpllowing building permit applications are exempt from undergoing a full concurrency review: room additions,
acce lI ory 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
imp ovements to your property. A Notice of Commencement must be recorded and posted on the jobsite
be -'ire the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co inencine work or recording vourAZtice of Commencement.
Lessee/Contractor as Agent for Owner I Signature offContrMor/License Holder
ST/{ TE OF FLORIDA I STATE OF FLORIDA
COI NTY OF ST. (_UC R_ COUNTY OF 3; . LAC i IE
The forgoing instrument was acknowledged before me
this i� C` day of DSO LN , 201.S" by
III Name of person making statement
Per onally KnownX OR Produced Identification
Ty p of Identification
Pro uced
I
I
(Sig ature of No=t4cl.49E27/2019
oP ft Public State of Flor
Co m' ission No.°King
ssion FF 93122
r/2019
The forgoing instrument was acknowledged before me
this iday of J(_ LEL>/ 20 by
Name of person making statement
Personally Known y— OR Produced Identification
Type of Identification
Produced
ature of Notary Public- State of
on No. LJ61�T ��f� (g*)Public State of Flori,
Danielle King
My Commission FF 931228
o►ao� Expires 10/27/2019
RE
iIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DAT
REC
IVED
`
A
COMjPLETED
Rev. 8 Q/17