HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL" PPLICABL INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Number:
Date: Permit
II
RECEIVED
also
Building Permit Application SEP 14 2018
Ling Development Services ST. Lucie County, Permitting
Pla``
and
SCANNED
Bu► ing and Code Regulation Division
230P Virginia Avenue, Fort Pierce FL 34982 BY
Cou tResidential
PhQj�ne: (772) 462-1553 Fax: (772) 462-1578 CoInmerc,%l ueie
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PEI , IT APPLICATION FOR: Roof '
PROPOSED IMPROVEMENT LOCATION;
Addr�'ss: IS6o'-� ��QGYpp��1 u.i�ip .(�o�se Lane ?64- 50,r+� C,u c., e 1 o d 24 9 g i
Legal lDescription:
i
CC(( f r, �� ��77 ?��
L � G.J LV. 3 Lod" G I -ZE3 K . 35-5432 ' 3L/g0
Pro jrty
Tax ID #: Lot No.
Site P
an Name: Block No.
Proje' It
Name:
Setbacks
Ii
Front Back: Right Side: Left Side:,
DETAILED
DESCRIPTION OF,,W.ORK:
o0a
W ail e C
CONI,STRUCTION INFORMATION:
b
Ad itI nal work to e e ormed under this permit— check a apply:
11 ❑Gas Piping Shutters Q Windows/Doors
VAC Gas Tank _ -
❑ Electric 0 Plumbing Sprinklers Generator 10 Roof Roof pitch
Total Iqq. Ft of Construction: l/1000 S . Ft.. of First Floor:
Cost Construction: $"f2-000 Utilities: Sewer Septic Building Height:
II
OWNER/LESSEE:
!loll jLt.S La cAe
CONTRACTOR:
NamelIlDouq)�S Loyu-
Name: pee IC4KA
t1
Address: 113 64 _rMAqu lli'j B4,X LGA6
Company: fDK, 60f;m . I
City: OOrbr SW4 Lkie State: VL
Address: GZG SW EvWdf CA%
Zip Code: 3' 9W7 Fax:
City: Ye(4- S21;H* Lu4e- State:,
Phone &o.W) R15- 91.55
Zip Code: 34953 Fax:
E-Mai i�
Phone No. LWO SZ16 " 0113
Fill in I lee simple Title Holder on next page (if different
listed
E-Mail:
State County License: CLC1331
from the Owner above)
or
If value
f 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
Na'Irine:
Name:
Address:
Address:
Citl• State:
City: State:
Zi Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Adidress:
City:
City:
Zip: Phone:
Zip Phone:
OW!ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I ce no work or installation has commenced prior to the issuance of a permit.
Ifythat
St. Luie 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,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
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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 poste on the jobsite
before the first inspection. If y intend to obtain financing, consult with lender or an att ney before
com��ne cin work or re rdi our Notice of Commencement
�
i
Signiature
of Owner/ essee/Contractor as Agent for Owner
Signa ure of Contract /License Holder
STATE
OF FLORIDA
'� L
STATE OF FLORIDA
�� / L I,j
COUNTY
OF it V f c _
COUNTY OF
ThJifor
oing instrum�rent was acknowledged.before me
day 3�4— 20by
The forgoing instru ent was. acknowledged before me
this day of •P 20�0 by
this'l
of
of person making statement
Identification
Name of person making statement
Personally Known OR Produced Identificatio
PersfName
onally Known OR Produced
_�
Type
of Identific��ipn
Type of Identificatio
Prolduced
{fJ
Produced
if AA
C J—�
0 AA1
(Signature of
- LSEN
(Signature of Notary Public -State of Florida )
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Co mission N
,,,���,,, KARE
SPRY P(�gli��
;z° `;State of Florida of ry Public
fission 07484
Commission No (Seal)
,N =
a;: My Cornmission Expires
June 12, 2022
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FRONT ZONING SUPERVISOR
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Cornmis 2J-4RE1/IEWS
�01922ROVECOUNTER
REVIEW REVIEW
REVIEW
REVIEW
W
DATE
RECEIVED
DA
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COMPLETED
Rev.
12/17