HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL"PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datig:G 69 � tg SCANNED Permit Number:
• _ St Lucie County LE
RECEIVED
Building Permit Application
Planning and Development Services P Z7 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 - .ounty, Pa m
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line }�
PROPOSED -IMPROVEMENT LOCATION
Add rel s: St• iB
Legal t escription: 1
Cs=9ol43-00 61,11-cps LcFk- \5 n
Property Tax ID #: 84Rt--70R- OI2210�-(ebb -a Lot No.�
Site Plan Name: Block No.
Projec 11 Name:
Setbalks Front Back: Right Side: Left Side:
I!�
DETP�IL'ED DESCRIPTION"OF WORK
11-�\C�v►n
CO,-NSTRUCTION. INf;O.RIVIATION:, `� _
0 {Ilna workto 2 ne orme under this permit —check a apply:
_ 111 _Gas Tank Gas Piping _Shutters U Windows/Doors
Electric 0 Plumbing Sprinklers E Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
IIIn
Cost of CI onstruction: $ 1`� .�(� Utilities: Sewer Septic Building Height:
01NNE LESSEE;
CONTRACTOR: `
Name u
efl s ell Ct
Name: I t
Company:
AddressOl l T
—,
Addres �i .3 05 a PS �s l�
City: - I C Stater
Zip Code: 3 ��1 �77 Fax:
Phone No. o� ?J -
City: � tti Stater
Zip Code: 0�3ggk Fax:
oRhone No. 5 v _7 yb
E-Mail: I'� v1 � I P,J` e 7PRAr, 4.Pr V I q -(I
Fill in fei� simple Title Hol er on next page (if di rent
from th i Owner listed above)
E-Mail ' re �J 0
State or County License: EGI S(¢s to
it value ofl construction is �2500 or more, a RECORDED Notice of Commencement is required.
S-U
MENUIL"CONSTRUCTION L N L
PlLt lE AWINFORMATION :.�.'..
DESIGNER/ENGINEER: Not Applicable
Na e:
MORTGAGE COMPANY: Not Applicable
Name:
,
Acl,ress:
Address:
City: State:
Cit�'-
State:
Zi
Phone
Zip: Phone:
FEEII'�IMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: —Not Applicable
Name: Name:
Ad ess: 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 certi I �y that no work or installation has commenced prior to the issuance of a permit.
St. Lud eCounty makes no representation that is granting a permit will authorize the permit holder to build the subject structure i which is n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
're.
struct Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
`1
In con, ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
I
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
I
The flowing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessostructures, swimming pools, fences, walls, signs, screenaccessory , rooms and accessouses to another non-residential use
WARNING
I G TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impro vements to your property. A Notice of Commencement must be recorded and posted on the jobsite
beforlel the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
If
Signature of Owner! 'Lessee/&nt-ractor asAgent for Owner
'Signa e of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF e
S TE OF FLORIDA,
COUNTY OF
The fprgo,ing instrument was acknowledged before me
this day of 20ffby
The for ling instrument was acknowledge efore me
this 77day of Vby
Name of person making statement
Narr/e of person making statement
Personally
Type
Known OR Produced Identification
of ld"tifi�tion
Personally Known S,�llllllllll` OR Produced Identification
Type of Identificafion
Prod
=.Notaiy Public State of Florida
Jojo Kuruvilla
My Commission GG 1290:89
164A Expken (17/2712021
roduced
48igna;70ota Public- S1 I
(Sign
tugp�yVublic
Comr
ission No. AC, /.,kq Qrq (Seal)
JENNIFER L ELWO
OW&MISSION # FF95
I$
EXPIRES February 11. 2
2
1400 39MI53
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV4
REVIEW
REVIEW
REVIEW
DATE
RECEJV,ED
DATE�IJ
COMPLETED
Rev. 8/2/17
i