HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO�MI
Date: %tt'% •:!�o X
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
RECEIVED
Building Permit Application OCT 30 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virgi�ia Avenue, Fort Pierce FL 34982
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:
Address: I 6 �ck'-
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Legal Description: ��(Jl� `� _ ���� Cal IL 51 CANNED
8 r _
RV
Property T i x ID #: / 15 S�� a% S C�CC -
Site Plan Name: ar t- - 1
Project Name: 5 CY
Setbacks Front Back: Right Side: Left Side:
Block No. a]
DETAILEDDESCRIPTION OF WORK:
CX-C C�J �rvi4e1 Seek �II4et 04etejymrv,_t
CONSTRUCTION INFORMATION:
Additional work to (ever orme under tis -checkpermit a apply:
11HVAC L_J Gas Tank Gas Piping In _ Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers [ Generator Roof Roof pitch
Total Sq. Ft; of Construction: (f�\ S . Ft. of First Floor: 1 Oki �k Sly CT
Cost of Construction: $ �I jsV Utilities: Sewer Septic Building Height:
1
OWNER/LESSEE:
CONTRACTOR:
Named
jw�ccl.
Name:
Company:
Address: ktQ(,) St SokGZ. 0U
Address: �D
City: �pi LUC & State:..
City-'�b( LUh.1-e State:f
Zip Code: IRY O Fax:
Phone No. l,'� -�D�- S�
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Zip Code: 3�-1CA9_ Fax:
Phone No. �� - �S�iU - (,OLD
E-Mail: �eY eZ 1��0 mush i . c U�]�
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Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Ol ner listed above)
State or County License: c - (A
IIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required. I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: I
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address 1
Address:
City: iState:
Zip: i Phone
1
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: I
Address:)
Not Applicable
BONDING COMPANY: KNot Applicable
Name:
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 certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Co I my 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
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, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of 6wner/ Less tractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The r oing instr en as acknowledg before me
this day of 20� by
Name of person making statement /
PersonallyiKnown OR Produced Identification ./
Type of Identifi n
Produced'
I
(Signaturelof Notary 5MW,
KA E S. NIELSEN
t�prn�e�.
Commission No. _;� `�=State ofl+�1a-Notary Public
Comm) w # GG 207484
My Commission Expires
June 12, 2022
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED.
DATE
COMPLETI
Rev. 8/2/17
/License Holder
STATE OF FLORIDA
COUNTYOF Wit, L_UCl C
The forgoing instrume t w�js acknowledged before me
this � day of lvK l� 20(9 by
130Y)n INA5S
Name of perso making statement
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notary PuTb6Yc- State of Florida )
Commission No.
SUPERVISOR I PLANS VEGETATION SEA TURT
REVIEW REVIEW REVIEW REVIEW
Notary Public State f rid.
Deena M Sabella
My Commission GG 2 oo
REVIEW