HomeMy WebLinkAboutBUILDING PEMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED,FOR.APPUCATIOMTO BE ACCE
Date: �W{IPJ ., Permit
DEC 13 2018
Building. Permit Applicati-0LPermittin"g Department'
Planning -and Development Services cie C- nty,l' i_'
Building and Code Regulation Division
rJ
1300 Virginia Avenue, fort Pierce fL 34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578 COf1 mercial Residential
PERMIT APPLICATION -FOR: —
To Select from dropboz, click arrow at -the end of line
PROPOSED IMPROVEMENT LOCATION:. /
Address: �'3 6 2 SCdH4,r3GrOU��i C'c�, Prrif sF,: %urr�- ,t"I
Legal Description: "� ' �vA3CC2r� �362 SCrszi_o yu-&u rytirtr.
PropertyTax ID #: -2 - G� - 7 U •/ (JV(ty - w.(xJ ,,=3 Lot No. -•,
Site Plan Name: Block No.
j
Project,Name: � - �e%QtfkeC `:Fl p. ' i✓n-i+ ;' " ,fir.; 17f� ,.r:.: ;
Setbacks ' Front'' 'Back'' ` Rig htSid'e': Left Side:"' ''"'`'
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DETAILED DESCRIPTION OF WORK:
lipt,6C�- ens- Od&W- 'Nr� 4—
SG�• =F�' sG�
SCANNED
BY;...
`St.lucie County
CONSTRUCTION INFORMATION: iu
HVAC LJ Gas Tank
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ ie)q B, V
Generator ,-
S Ft. of First Floor: _
Utilities Sewer E]Septic
Windows/Doors
11 Roof ' Roof pitch
Building Height:
O
CONT-RAC-TOR
•--•-°
Namre G,"f CO>\► ,,'fit
Nam CkRLLtnb>2�iFpyt� t Orl✓Lc4riu�✓ .
Address q•311?__ ,5Crt+-(JIPrL6'*1
Complanjl?Pejfrj
City: "e Stater
Zip Code; 3it qe(R. • Fax:
Phone No. "Z(i 3 — _7�Lb 1"
Addresss '3fJ d S�(o
City: - State:l
Zip Code: _'3N1 Sd(j Faz: >
;Phone No. �i 1) — 7tEt3' L tg%iy
E-Mail: 505aya,vly) -1 & &M44'ri rGeM -
Fill in fee simple Title Holder on next page ( if different.
from the Owner listed above) - _ -
E-Mail: axi o Ghhtl tnl (2? L,GokA4
State or County License: Ci 6 C a7 (P�'•
if value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTIDN'LIEN L'AW INFORMATION:
DESIGNER/ENGINEER? ? ; '—'Not Applicable MORTGAGE COMPANY: = Not Applicable
Name: Name:
Address: -.... , Address:
City: 7 77State: City: State:
Zip: Phone, Zip::. Phone:
FEE SIMPLE TITLE HOLDER: ` _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City::
Zip: Phone:. .
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a.permit to, do
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 applicabl"e'Home Owners Association rules, bylaws or and covenants that may restrict or pr6hlbit 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
imp vements to yo r operty. A Notice of Commenceme t must be rec rd d and posted on the jobsite
befo a the first insp cti n. If you intend to obtain financing ,consult with en r or an attorney before .
co encin w rk r r ordin our Notice of Commence ent:
Signatu a of w r/ Lest/Contrac or as Agent for Owner
Signatu of Contracto Ucens Ider
STATE OF FLORIDA
STATE OF FLO I A.J
COUNTY OF —Li Ui lc�
COUNTY OF OIYI G.r
The or Ing instrument was acknowledged before me
The fo- oing instr mgnt was acknowledge before me
'201
this ay of ITV?,YY�Io4 Y . 20L by
this i ay of Wf ' by
�zf1�_.ker�t�rnG
kenr�t=Vi D Y-�atinG -
Name of persoJl making stateme -
Name of pers n making state "nt
Personally Known 1 V . OR Produced Identification
Personally Known OR.Produced Identification
Type of Identification
Type of Identification
Produced
Produced
t/W1/X7c y V l_�
-
(Signat a of Nota State
i�ir_ A fJ ILLERM.
(Signature Notary ' , ate oAtia=11I,MILLER -1`1
:.
Y COMMIS FF1886S5' ` -I'
Commission -No. (
''= MY COMMISSION k FF 188655
Commission - �b XPIRES 06ftjay 11, 20%txPIR'
E S February 11, 2019 „
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- - - - — - ,40,)38E-0:63
REVIEWS`''
FRONT
ZONING
SUPERVISOR'
PLANS-
VEGETATION
SEA -TURTLE
MANGROVE
COUNTER--
REVIEW
REVIEW,
REVIEW
REVIEW
REVIEW
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REVIEW -
DATE
RECEIVED
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-
DATE
COMPLETED
Rev. 8/2/17