HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLI BL�+ INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - jX SCANNED Permit Number:
RECEIVED
Building Permit Application AUG A 2o1a
Planning and Development Services
Building and C�'de Regulation Division ST, Lucle County, Permitting
2300 Virginia q, Uenue, Fort Pierce FL 34982
Phone: (772)p' 62-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT AR LICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSE61IMPROVEMENT LOCATION:
Address: 6,, dV 4so RoaIeS OlUl) Oil/ P(,-e_aCC- 3"1-1c,
Legal Descript� n: )We-ty(?W PA'i) Ur�LT C1 — 8Lk 11S ZOTS to Avb I I11
11
Property Tax ID #: 13o l " 611 " 030-- O 0 o/S Lot No. 10 a -
site Plan Name: 1 Umee AbhiTi 0/v Block No. 1�S
Project Named %URNex kbD'T'au r
o � � , s
Setbacks F ilont_/7 7 Back: 'Right Side: f Left Side: 10 o 1
FDETAILED DESCRIPTION OF WORK: /�a� cj
A u Tfo
�l/,9-0 1-o e iCfS1-cYJ6— PpSl li ce .
. i
CONSTRUiCTION INFORMATION:
Adclitionalworktobebej rformed under tispermit-check all Unt apply:
HVAC LJ Gas Tank E]Gas Piping _ Shutters � Windows/Doors
®Electr c � Plumbing ❑Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft' If Construction: 1 6S S . Ft. of First Floor: a8 7 3
Cost of Con ;,ltruction: $ ODD Utilities: Sewer 2 Septic Building Height: t✓s
OWNER/ ' ESSEE:
CONTRACTOR:
Name e z —1upiveg
Name:
Address: 66oq Ph -So Rob e-s iBLo b
Company:
City: F111. Ptroce- State: T=L
Address:
,c
Zip Code: 11 3 'I 99 I Fax:
City: State:
Phone No. �1 117 i ^61ifS
Zip Code: Fax:
E-Mail: N (6/n •ode7-
Phone No.
Fill in fee Title Holder on next page (if different
E-Mail:
State or County License:
Imple
from the �Iwrier listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: G, 0- l Met P CFt'1S190 6
Name:
Address: 6667S F(A-1-i'i.iv%0 R b
Address:
Ci ty:meladukve u i ( E State: _
City: State:
,
Zip: 3217DVI Phone 32/- a3 -- 393
Zip: Phone:
FEE SIMPLE t1iTLE HOLDER: 1k Not Applicable
BONDING COMPANY: of Applicable
Name: N
Name:
Address: $I
Address:
City: .I
City:
Zip: Phone:
Zip: 1111 Phone:
OWNER/ CO1�1�1
RACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noork or installation has commenced prior to the issuance of a permit.
St.l Lucie Countyakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in confii�with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Pleasdilconsult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideratio l iof the granting of this requested permit, 1 do hereby agree that I will, in all respects, perform the work
in accordance w th the approved plans, the Florida Building Codes and St. Lucie County Amendments.
TF�e following bilding permit applications are exempt from undergoing a full concurrency review: room additions,
accessory struct�i res, 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
improvement's to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the fig�st inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing I,Work or recording your Notice of Commencement.
vvwa N_ _ 114:7vr11_
Signature of � wner/ Lessee/Contractor as Agent for Owner
i
STATE OF ,,! ORID 4
COUNTY OC'.il
The forgoing, instr ent was acknowledge before me
this da !of 20by
Na a of person making statement
PersonallyK' own OR Produced Identification
Type of Iden ificat'on
Produced
�I
(Signature f Notary P Of -
�Pa,,,�e,� F-FA-Iftiq S. N I E L S E N
?_� ��;State of Florida -Notary Public
Commission�'No. 5* Com(iSWl)On # GG 207484
P My Commission Expires
�'l''�%iiii ��`� June 12, 2022
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN
VEGETATION
SEA TURTLE
MANGROVE
i
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED ���l
DATE
J
4
COMPLETED
,�?
Rev. 8/2/17