HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONJ
ALL APPLICABLE INFO MUST BE COMPLETL:.. -3R APPLICATION TO BE ACCEPTED (�
Date: %/ Z�I� Permit Number: `t
RECEIVED
�3uilding Permit Application NOV 21 1018
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Courit.,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone j,, (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line —W
PROPOSED IMPROVEMENT LOCATION:
Address:, 6531 Wkarl q G rGlle_
/� li it
Legal Description: L o� 38 1'J
IBCCarrII`Dq �D +h-e o Io(4-- 4
Property Tax ID
Site Plan Name: _
Project Name: _
R�A=
Setbacksll. Front Back:
r'e ro ro(e d in
r O O O A -
Right Side: Left
hvy)6 i�z
Lot No. 3 Q
Block No. R-
,,DETAILED DESCRIPTION OF WORK: o
�'t.Slolrr�iC
46A,4 .Co M-I � JP 0,4 rif t
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit— check all apply:
�HVAC _ Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing OSprin s Generator Roof � Roof pitch
i
TO •al M of ConstrUcti9n: S Ft. of First Floor:
Costrof * -CUM Utilities. Sewer aseptic Building Height:
i� _-7
OWNER/LESSEE:
CONTRACTOR:
Name G glen n M US e-
Name:
Address: P 0. 13A 0i )00q
Company:
City: Ayi- s+- bvLo e State: FL
Address:
Zip Code: Fax:
City: State:
Phone No. �7-7 9 — L4 18-393_1_.
Zip Code: Fax: f'?
E-Mail::ft.%�enyl V Gthm . r'nM
Phone No. 11
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION-M N LAW INFORMATION:
DESIGNER ENGINEER: Not Applicable
l,
MORTGAGE COMPANY: _ Not Applicable
Name: e -AV
Name:
Address: R,9D 69
Address:
City: State:
City: State:
Zip: J5� !P, z Phone 77Z - Z f 7-6 7 ?'S—
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _-Not Applicable
BONDING COMPANY: //Not Applicable
Name
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 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.i 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
cnmmencme work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIPA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The Cgoing instrument was ack owl me
The forgoing instrument was acknowledged before me
�elefore
this N\ day of ���C�l�y
this day of , 20_ by
Name of person aking statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature', of N a Public -St orid*RyLYNNMELTM
(Signature of Notary Public- State of Florida )
Vy COMMISSION ii FF 902495
o5&SCl Commission N,.� �,.S ».2D,g
Commission No. (Seal)
� E1i1p�lF-
OF ,�
REVIEWS'
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED!
II Ep
DATE
COMPLETED
tev. 8/2/17