HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLIPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datp1: Permit Number:
it L SCANNED
�t Lucite RECEIVED
Building Perm&Woo Iication SEP 4
Planning and Development Services 1 2018
Buili,iing and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 _
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentia-F
I
PERT
IT APPLICATION FOR: To Select from dropbox, click arrow at t e end of line
PROPOSED
IMPROVEMENT LOCATION:
Adcl4ss: 10L Kwen,vV,40 IAPr, T,seo 6eg_e_h ,►�L Jg9AS7 ,� �1,I1 �I^, r {�^ /'
Legal (Description: -roe OF wMvw W �- 67 FT 6F L� r7 ALL. 1-V� 0 MO C W • �0� r l OF
�.o q AND A-E P "S ON S 2Zp //5 OFLO T ,3 orb � -L331
Property Tax ID #: y't h�Qi'� �' V Q q' CVO .3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
III
-DE1IAIL'ED DESCRIPTI.ON OF WORK:
e P I act % C)01�
t
J
CONSTRUCTION INFORMATION:
i,tiona wor to e e orme un er t is permit — check a apply:
I� HVAC 11 Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
'dElectric 0 Plumbing Sprinklers E] Generator Roof M/72 Roof pitch
Tota; Sq. Ft of Construction: dO S . Ft. of First Floor:
Cost of Construction: $ IL-600 Utilities: Sewer ❑Septic Building Height:
OV1/N
ER/LESSEE:,
CONTRACTOR:
Na i'el
Add
Cityi�
Zip 'Code:3Lq
Pho
E-Mij
III To cohSoh
K//c�iN
Name: Dee '/
I� �00�- '
Address:� L-� i L aW SW &rt "
City: Porgy- 300iState:PL
Zip Code: ,3�C1s3 Fax:
Phone No. ` 9L-5 ?j - (311,3
E-Mail: POk-4o I-i,rllol . I Kc P9y`2C61,C_&w.,
less: IOL (�/1�JG�irrC�1 OrCompany:
Twgn QG(ftl State: ��
g 5pp7 r Fax-
Ie No. r%�Z U�U -Z,ZS
ail:
Fill i I1 fee simple Title Holder on next page ( if different
fro 'll the Owner listed above) '
State or County License: (f—C i 3ILL05
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
91L4 Q 2) 3
SUPPLEMENTAL CONSTRUCTION LIEN L'AW",INFORMAT,ION .
i , ..
DESIGNER/ENGINEER:
Nan
I
Ad
_ Not Applicable
I ie.
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
I
ress:
11,
Cit
zip.
State:
jl Phone
City: State:
Zip: Phone:
FEEflN`"SIMPLE
Name:
Ad
Cit
TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
'ress:
Phone:
Zip: Phone:
Zip-�l
OWiV,IER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cert fy that no work or installation has commenced prior to the issuance of a permit.
St. Lu lle County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which Iis in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
struct re. 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,
acces�i ry 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, 5gqsult with lender or attorney before
commencing work or recorditlg your Notice of Commence nt. / //
re of Owrfer/ Lessee/Contractor as Agent for Owner
ST TE OF FLORIDA t
CO�UNTYOF
The for oing instr ent as acknowledg before me
this day of 20LL by
I _ 1 Y Al
Name of persol making statement
Per onally Known �►// OR Produced Identification
Type of Identification
Produced ---) n ) r,
Signature of Con factor/License Holder
STATE OF FLORIDA 6
COUNTY OF
The f r oing instr ens acknowledg—Lbefore me
this day of 20T by
Name of pers making statement
Personally Known OR Produced Identification
Type of Identification
Produced
r \
(Sig`; ature of Notary Public- State of Florida) (Signature of Notary Publid- State of Florida )
Co (mission Cho"YPi'Fo KAREN S. NI(C )EN Commission o.,'. P6'• KAR S. NIE �13
�; Florida -Notary Public ae State of Florida -Notary Public
o Commission # GG 207484 rs Commission # GG 207484
F P����� My Commission Expires %',2 �, P�,a?.� My Commission
une 12, 2022
RE IEWS FRONT I ZONING SUPERVISOR PLANS VEGOATIO _ GROVE
�I COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED
Rev.B%2/17