HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONPPLICABLE INFO MUST BE OMPLETED FOR APPLICATION TO BE ACCEPTED -(5 v_Qy -� V
Permit Num er,- 1,7tb-�mg
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By
BuildingPcLi-rmitFA9pnip)�(iication Permitting Department
ing and Development Services St. Lucie County, FL
ng and Code Regulation Division
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PE �IMIT APPLICATION FOR: Concrete 0
PRbPOSED IMPROVEMENT LOCATION:
Description. 269 35 40 S 96.24 FT OF N 287.48 FT OF S 1/2 OF SE 1/4 (40)(OR 1741-2649; 3486-234)
ierty Tax ID #: 2426-431-0002-000-2
Plan Name: MIKO
ect Name: MIKO
Jacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DE fjAILED DESCRIPTION OF WORK:
�� p gel .�� V-e 1,14 �
CONSTRUCTION INFORMATION:
Aclaitionalworl(tobanerformedunder this permit— checK all apply:
OHVAC 0 Gas Tank E]Gas Piping _ Shutters ❑ Windows/Doors
0 Electric El Plumbing Sprinklers E] Generator E]Roof Roof pitch
Totl I Sq. Ft of Construction: y Xz> o SDI S . Ft. of First Floor:
Colt of Construction: $ � �. � b O,y 0 Utilities: Sewer Septic Building Height:
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OWN ER/LESSEE:
CONTRACTOR:
N me 1,? �`� t3
Name:. y5� VV/
Ac 21 � d, � AL `
Company: DECORATIVE CONCRETE SPECIALIST OF SF LLC
tlress�ll
Gty:ot- State:FL
Address: .,j
Zi'I Code:47 97- Fax:
City:y '1 2i 'C..ez)(J C- State: FL
P ne No.
Zip Code: 34984 Fax: _
E-Flail:
Phone No. 772-528-5409
Fill in fee simple Title Holder on next page ( if different
E-Mail:,
fr�m the Owner listed 'above)
I I
State or County License: CBC 1260973
If 'slue of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S
'PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:IQ
Clt�:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
?54 !$Lo Bi I4-rn v L 51
'rn+�-� S� ( �. State: F-
111.34984
Phonenz-Lessees
Zip: Phone:
FEI
SIMPLE TITLEHOLDER: 4 Not Applicable
BONDING COMPANY: Not Applicable
N
A
'� e:
Name:
Address:
City:
dress:
Phone:
Zip:Phone:
Zi�
0%%j ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I c1�cie
ify that no work or installation has commenced prior to the issuance of a permit.
St. County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whid,h is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
stru j ure. 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 a .I ordance 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,
acc ssory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
W�RNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
imRR'rovements 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
corimencine work or recordine vour Notice of Commencement.
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a ure of O ner/ Lessee/Contractor as Agent for Owner
Si ture of Contractor/License Holder
S
jATE OF FLORIDA
STATE OF FLORID/Q�
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COUNTY OF"
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say of 20 by
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this day �' 20 by
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Name of pers making state a
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Name of person g statement
Personally Known Produced Identification
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uc entification
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Type of Identification
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Re 8/2/17 �%/J/