HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
9 Jo� 1-dots Permit mber: cJ
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Building Permit Application SEP 2 4 2018
e Planning and Development Services
Building and Code Regulation Division Permitting Department
1�I7
23001',,�irginia Avenue, Fort Pierce FL 34982 St. LU C l e C47 ty, Fl-
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PER dM'� IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5 S / 3 ljl%cligg / U, CoAr Xe.4ce r4, 3 -/992-
Legal Description: � en'c24 ra Q _rki S i 411
I
Prope I y Tax ID #: 3 % -1 (P 5^ " D-U'*�) CWgl tbt No. 3-1
Site Plan Name: Ai V0_4 e_51—Are.S 04 ; T 08 Block No. .5 7
Proje fl Name: g en o- � ro
setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Trisrr+ll ge.1��2/�rv/l on ee�i s� �e vF /laUSe
�Oi �� aNL=yrsi�'rI� Oe e &J I upere 114-d
�i
CONSTRUCTION INFORMATION:
Aadit�ona
CIHVAC_
war to b
(e�e orme under this permit- check
Gas Tank ❑Gas Piping
a
that
IL-11
apply:
Shutters
a Windows/Doors
L_I
11
Electric 0 Plumbing
Sprinklers
Generator
Roof Roof pitch
Total
Sq. Ft of Construction: /i%�,+
S . Ft. of First Floor:
1V1,'
Cost If
Construction: $ A66 -G-U
Il
Utilities
Sewer Septic
Building Height: /lJ�/�
OWNER/LESSEE:
CONTRACTOR:
Name
Address:
City:
Zip Ci
Phone
E-Ma
Fill in
from
De- C. - OenCiII
Name: 5,4Me AS OWAe2
5 S 1 IRC leo2!Z 1)12
Company:
Address:
City: State:
Zip Code: Fax:
Phone No.
/
4k I 101 e/L c e- State:
de: 3S1 c $Z. Fax:
No. 2151 3 / 3 - !R-1 2 8
l: J Venc;I 1 O 1 1a X141400 , Cv/?A
Ifee simple Title Holder on next page ( if different
he Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Nam II:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: 11 State:
Zip: II Phone
II
Address:
City: State:
Zip: Phone:
FEE S�MPLE TITLE HOLDER: _ Not Applicable
Namee:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City: II
City:
Zip: II Phone:
11
Zip: Phone:
OWN IR/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 cei— 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 acco�jdance 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,
accessollry 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
impro�' ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor 1 the first inspection. If you intend to ob ing, consult with lender or an attorney before
cnmrnPncincs work or recordine vour Notice o ,684 a cement.
Igo aeG essee/Contractor as Agent for
ken
o
Signature of Contractor/License Holder
I
v
c
STA 1E OF FLORIDA
E
STATE OF FLORIDA
COUNTY OF
COUNTY OF
2 `;7ti_�
The for oing instru nt was acknowledge efore m
�by
= °'T 9
he forgoing instrument was acknowledged before me
20 by
this day of 20
iN
his day of .
I
Na rson making statement
Name of person making statement
Pers QI nally own OR Produced Identification
Type,bf Identificat of
Personally Known OR Produced Identification
Type of Identification
l (�(r '
Produced
Produced
(Signature
of Nota ublic- State of Florida) v
(Signature of Notary Public- State of Florida )
ComGI
fission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
f
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8V2/17