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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL A rPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DatE SCANNED Permit Number: 10Ub (l ! (w
7Buin
L'
ju Q U RECEIVED
�t. Lade Countv
Building Permit Application AUG ®8 2017
Development Services Permltting Department
St,LYCIe County
Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Pho I e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER
IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
;PRO
;OSED IMPROVEMENT kOCATlON -
Addre s: qQ oyA ,RA o9_9.
Legal I escription: 1111c,,O /u;-/"yic 4_14-4x A 7 , i/�.Y !;AZA - 294144 4o7" % a
Prope y Tax ID #: J� S-/did /0 Lot No. / Z
Site Plan Name: Block No. AX
Proje Name:
Setba ks Front Back: Right Side: Left Side:
DE T [LEDDESCRIPTION OF`WO.RK:'
)2,&a, /Ac1Z Tv Z f/�-3v ✓fL tGv �,�
%'2/wc,a wiz / .;1,we-
CONSTRUCTION INFORMATION:
Addit5na wor tobenerformed un er t is permit— c ec al apply:
❑ VAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
❑ LI" lectric Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch
TotalI
q. Ft of Construction: L2 7 9 S Ft. of First Floor: %! JG
Cost 0 Construction: $ S CyU Utilities.- _Sewer ❑Septic Building Height:
OW
DER/.LESSEE;_`
CONTRACT R:
Namel
Addre
City:
Zip C
Phone
E-Ma
Fill in
from I
5V5AL1_ T, ` —120S /Z
Name:
Company: ire
s: r1' 0 Q &I.A !2>Z
,i211
P 4ti./� State: �L
de: ,; SF S-7 Fax: .t:/p
No._ 7/ - ©e 4;nt
Address: /"? C? ;Jcair 132
City: T, SA/y ,��,L /f State: %�L
Zip Code: 37c9S Fax: T7L-3JSd � ►�
Phone No,
404
iee simple Title Holder on next page (if different
a Owner listed above)
E-Mail: Ro51,.)
State or County License:
If valu$lof construction is $2500 or more, a RECORDED Notice of Commencement is required.
SOPLEMENTAL
CONSTRUCTION LIEN..LAW INFORMATION: ;
DESIGNER/ENGINEER:
Narr
Add
City.
Zip:
Not Applicable
e:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
ess:
State:
Phone
City: State:
Zip: Phone:
FEE
Na rT
Add
City
Zip:
§IMPLE TITLEHOLDER: _ Not Applicable
i1e:
BONDING COMPANY: _ of Applicable
Name:
ess:
Address:
City:
Phone:
Zip: Phone:
OWN R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi that no work or installation has commenced prior to the issuance of a permit.
St. Luc County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
struct e. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In con deration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acc dance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fo owing building permit applications are exempt from undergoing a full concurrency review: room additions,
access ry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WAR I ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr ,ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comniencing work or recording your Notice of Commencement. ]
Sign ure of 0 er/ Lessee/Contractor gent for Owner Signature of Co tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COL NTY OF S!-' WCA-e COUNTY OF Sd'
The f )rgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this -'I day of Pas,- , 20�y this -1 day of Aar- 20ff by
CA S-1,� jam..,, t 214M KJ_.
Name of p rson making statement Name of person making statement
Personally Known OR Produced Identification _� Personally Known OR Produced Identification JL
Typ 'of Identification Type of Identification
Produced Produced
�• I
(Sigr ture of Notary Public- a of Florida) (Signature of Notary Public- State c6Frbrida )
Com ission No. (Seal)M:C-�'I-':
Commission No. (Seal)
1, ��I I IINp �i� �•115 ����!RE IEWS FRONT ZONING 0 PLANS VEGETATION SEATURTLE MACOUNTER REVIEW REVIEW REVIEW REVIEW R IDATRECEIVED o=3yDAT aXCO jPLETED zooRev.8 /17 ;, TY'1v�0
Q 0 H v Q
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