HomeMy WebLinkAboutBUILDING PER4MIT APPLICATIONAll IPPLICABLE INFO MUST BE COMPLE i i"�FOR APPLICATION TO BE ACCEPTED ^ -f
Da Ile: `' �� • ($ Number:
SCANNEDPermit
BY
St. Lucie County RECEIVED
R-4
Building Permit Applicatio JUL 2 6 2018
Planip,ing and Development Services �T. Lucie
County, Permitting
Building and Code Regulation Division
2300I Virginia Avenue, Fort Pierce FL 34982
Phorile: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X,
PERMIT APPLICATION FOR:
Memo OSED INPROUEMENT LOC TIO0.
Addres'I �e �i �� s ��- Q-y hT• �crerrc� . 3 `18G�
Legal De scription: (Z�' 5�1 � �(n-..i�" `�"� P I"� ( .rdl 3 5' (DP, (o (r�- h(6
II .
Propert'l Tax ID #: �� �ZI - RA - Oo3S -• 00o Lot No. 3�
Site Planl Name: Block No.
Project 'lame:
Setback l Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
/�� �"
112 a -,,A P9,.ce_
hI
CONST +UCTION INFORMATtO
itiona Iwor to a pe orme un er t is permit- c ec a that apply:
anical _'Gas Tank _ Gas Piping _ Shutters .. — Windows/Doors
_%1ec
!/ric umbin
vPf g _Sprinklers _Generator _ Roof Pitch
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Total Sq. Ftiof Construction: Sq. Ft. of First Floor:
Cost of Construction: $ f� $, 0 OD Utilities: Sewer ✓Septic Building Height:
_
OWN ERI/LE--SSEE:
CONTRACTOR:
Name / d(r�5 Lv
Name: 61�[ET'.,• GRGST-.
Address: �r1� S"5 ('i�Y s �K (
Company: ' CR:i� % &JsrR.�C_7-zoA_1
City: State: r
Address:
—.
Zip Code: 'i-�C I Fax:
City: - _AF �eicz� State: ��-
Phone-No. J� 'li 5.3a3
Zip Code: 3 Fax:
E-Mail:
Phone No Z " 4(ot -�S�S 7-72-' 3 -Io'
Fill in fee si ple Title Holder on next page ( if different
E-Mail c''St�Y `'�`� • �°^""
State or County License CZ G 0�6pj�
from the O�(lner listed above)
f�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
t
PPLEMENTAL CONSTRUCTION LIEN LAW I FORMATION:
DESIGNER/ENGINEER: of Applicable
MORTGAGE COMPANY: t,,* of Applicable
Name:
Name:
Address: �,,��,,
City: State:
,Ad.dr�ess: t
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:
OWNER/ CONTRACTOR AFFINIT: 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. '
i
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 our Notice of Commencement.
G�
Signat Owner/ Lessee nt�_�Agent for Owner
Signature of Contractor/License Holder
S TE OF FLORIDA
STATE OF FLORIDA
C. UNTY OF
COUNTY OF
The forgoing instru ent was acknowledge efore me
The forgoing instru e t was acknowledge efore me'
this day of 20by
this day of 20 by
(N'a'eie of person acknowledging)
(Name of person acknowledging)
` 1
�C
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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Commission No. # uolsc� 0 ;.®,:,
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Commission No. !K-
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REVIEWS
FRONT
SUPERVISOR
PLAN
VEGETATION
SEAT
ZONING
COUNTER
REVIEW
REVIEW
REV
REVIEW
REVIEW
RE I
DATE
RECEIVED
DATE
COMPLETED
r
ev. 7/2014