HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -
Date: I\�y Permit Nt_!;nber:
_ SCANNED
BY RECEIVED
s r WS U*
�i Building Permit Application AUG 14 2018
Planning and Development Services
Buildin , and Code Regulation Division ST. Lucie County, Permitting
II
2300 Virginia Avenue, Fort Pierce FL 34982
Phonef; (772) 46271553 Fax: (772) 462-1578 Commercial Residential -
PERMIT
APPLICATION FOR:
PR®PpSED
1,N3' U �M'EN L(7CAT0,
Address' a-*� OL��B�I AOF �� 1/c�c.C- , p L
Legal Description:
Property Tax ID #: I .3 3 7 9.916 ®d. Lot No.
Site Plari Name: I J� F-f /2S &v 61 4c-/ �- Block No.
Project '.ame: 1�( tZ f�S �C�'✓1-r`- fZ�i Z
Setbacks Front Back: Right Side: Left Side:
r )`7 /4 e � r i P ,� v cco� b �� i CP : 1I PO ice- , ,-II
C " e )ef V76ep.,Z zc r 14 e 1. ,vow T/cL 7:5, F74---;f , A�- :--t— /iL a H tj/ -E:" �v
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A 7 iP7 ! w 1ncao,2 fI /%PF TXZ-55E—!P' . n.Fw & 4-Ft7A iG* L —,Izz &'S
Aaaitionai worK to oe perrormea unaer tnis permit- cnecK aii tnat apply:
f%M chanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
f_'7I ctric II/Plumbing _ Sprinklers _ Generator woof 3 Pitch
Total Sq Ft of Construction: 12-5-4
Cost of C onstruction: $► D 2 1 o o 0
Sq. Ft. of First Floor: f Z , 0
Utilities: _Sewer _Septic Building Height: �% F
OWNER%LEA-SSE
CU 3RAC'1'OR:
Name 5�R A 2,60 Ittz. 4-1 1-
Name: /I L i5 exezq e 0 °'Z
Company: 6/v�c
Addresis: "Z-j92-'-
City: y'C�G 5 i c�c Stater
I��. 2-
Zip Code: `� �f �-i Fax:
P46ne Flo.
Address: , 3 /1/cv ji`72f�T� L/V
iC State: - C
City: �,lilD� 5i �
Zip Code: %4 j 0 _3 Fax:
Phone No °7 7 Z Z-L' 1-( I 1
E Mail:
Fill in fee
from t
simple Title Holder on next page ( if different
l e Owner listed above)
E-Mail S fS� %f�>E./�'TJ•
State or County License e67C
If value o',f construction is 2500 or more, a RECORDED Notice of Commencement is required.
Sl1PPLEMENT ACC? S aUC
IaN E.IEN LAW 1
FQRMATtO ,
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
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 AFFIDVIT: 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.
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, i
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.
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of Contra c r tcense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledge before me
1` V°�
The forgoing instrument was acknowledged before me
d
this day of . 20 by
I.JName
this � day of L1q 20YA by
of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced ' 1. .L
Produced-
(Signature of Notary o ION#GGO?2o2 F
(Signature of Not J-GIVENS
P ' ;«? M�Cp1R M, DeCafibet Ith UndeN+ritec:'t
Commission No. �, dlb��P IIo
- ::: -, MY COMMISSION # GG 02425
Commission No. PIRES:De�1�6,2020
Bon
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'%� ;o?•' BondedThtuNota�yPublic ndenvriters
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