HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1`� � �� SCANNED Permit Number:
0, _ , BY RECEIVED
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K Lucie Count/
IBuilding Permit Application JUL 3 0 2098 flanning and Development Services ST. Lucie County, Permitting
'Building and Code Regulation Division
300 Virginia Avenue, Fort Pierce FL 34982
?hone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 4 f N'%
P OPOSED IMPROVEMENT LOCATION:
Adtlress: Q. 1 1 1 Q i--� fir`
I Description: k.�-2 -t� C_\T�
Property Tax ID #:
Site Plan Name:
4 D �`� �®� f%�% & & f�� ` Yot No.
Proj i t Name: 1 ,3>'� O ,A�� L� %; �_�.'l�
Setb I,cks Front Back: Right Side: Left Side:
DET�I'LED DESCRIPTION OF WORK:
I�
Block No. % CO
CONSTRUCTION INFORMATION:
A itio' a work to be nerformed under this permit — check all apply:
�H I AC L__I Gas Tank []Gas Piping _ Shutters a Windows/Doors
El ctric ❑ Plumbing EISp inklers E]Generator E]Roof Roof pitch
Total Sq. t of Construction: b cp S . FtFtj. of First Floor:
Cost of C , nstruction: $ , UCH Utilities: L_I Sewer _ Septic Building Height:
OWNER LESSEE:
CONTRACTOR:
Name L C 6
Name:
Company: dLA wki <
��1 1
Address: Z
City: r�l &Z1z"Op State: Ot_
Zip Code: 3 Fax:
Phone No. 2
Address:
_
City: ✓- L.,� ��
Zip Code: -,;4 Fax:
Phone No. �? `1 '7-_�--
E-Mail: cam. lvl
State: �_L
e ^� Z
fL
E-Mail:
Fill in fee si I pie Title Holder on next page ( if different
from the Ovi�lner listed above)
State or County License:
1 Z4S>_ (�
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
ICity: State:
City: State:
Zip: Phone
Zip: Phone:
EE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
i ame:
Name: -
I, ddress:
Address:
City:
City:
Zip: Phone:
p: Phone:
0 NER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I c �rtify that no work or installation has commenced prior to the issuance of a permit.
St. ucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
is in
which 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 c � Psideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in a cordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The ollowing building permit applications are exempt from undergoing a full concurrency review: room additions,
acce1i 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
befo�ie the first inspectio . If you intend to obtain financing, consult with lender or an attorney before
comenci k gP-fe-c0_ci;4ng ypur Notice of Commencement.
I -
Sig f Ow r Lessee/Cont r as Agent for Owner
Signature of Contractor License Holder
lure
A�IE OF FLORIDA
STATE OF FLORIDA ,r l.'V
OUITY0F Sk, L-0zv�
COUNTY OF -�l
he The f rgoing instrument was acknowledge before me
•SU\y �
The f r ing instrume t w s acknowledged before me
this QA day of , 20 by
thisday of 2l by
'k�' l.k \" c\"it
aezv' 9"
IIName of person making statement
Nof am erson making state ent /
V
Personally Known OR Produced Identification
Personally Known OR Produc d Identification
Type ofl Identification
Type of Identification
Produc d 1D L
Produced r( I%Q K
I
(Signatil a of Notary Public- State of Florida ill
(Signature ohial PuE� ic- State o Florida )
2 MARIE GIVENS
Commission No. �4 �" •: A�jgslON#00022023
ommission No.
=PEAK:
�. EXPIRES: December 16, 2020
` Notrlry Pubyc, = :StMr61 Florld>t
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lillillaim$
. . ft"sUon,0 FF 980036
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a My Comm. fir
as Apr 7, 202
REVIE FRONT ZONING SUPERVISOR
PLANS
VEGETA 10 ' �� Af t
11110"11�_
i COUNTER REVIEW REVIEW
REVIEW
REVIEW
I
DATE
RECEIVE ,I
DATE
COMPLET D
BID. 18
Rev. 8/2/17