HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr � �
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: OUwl"lJ
St. Lucie County
----- — _ __ RECEIVED
Planning and Development Services Building Permit Application MAY 0 21018
Building and Code Regulation Division _ _ _ _ PenNtting Departmen,
2300 Virginia Avenue, Fort Pierce FL-34982 St. Lucie Coun'•
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Renovation ®_
PROPOSED IMPROVEMENT LOCATION:
Address: 5503 Winter Garden Parkway Fort Pierce FL 34951 t 4
Legal Description: LAKEWOOD PARK -UNIT 12- BLK 160 LOT 18 (MAP 13112S) (OR 3203-2680)
Property Tax ID ti: 1301-614-0108-000-9
Lot No. 18
Site Plan Name: _ Block No. 160
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: Y
C9 t.OAi (.L5 ��"
l�olcG •�-
12wm r • i '
CONSTRUCTION INFORMATION: f
rtiona wor to be ertorme un er this permit— check a apply:
1]HVAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
Electric Plumbing[]Sprinklers'Generator -Roofs Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
(�
Cost of Construction: $ 19 S . OO Utilities: Sewer Septic Building Height:
OW N ERAESSE E:
CONTRACTOR:
Name O,v_
!S
Name:
Address: N01o4e
ni
Company:
City: FA �V( e rc 0—
Zip Code: i)!f9S) Fax:
Phone No. i7
State.FL
Address:
City: State:_
Zip Code: Fax:
Phone No.
E-Mail: U�I�fS 17G/S� ��cfp%/ CLfnT
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW'I'NFORMATION
Name: — -- -
Ad dreSS: 5503 winter Garden Parkway Fort Plerm FL 34951
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: —Not Applicable
Name: -
City:
Zip: Phone:
MORTGAGE COMPANY: _Not Applicable
Address:
City- State:
ZIP: Phone:
BONDING COMPANY:
Address:
Zip:
_Not Applicable
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association4nd 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
co menc. ng work or recording our Notice of Commenc emt
en .
i
Si ature of Owner/ Lessee/Contractor as Agent for Owner
Signature o1CLontra ctor/License Holder
STATE OF FLORIDA
i
STATE OF FLORIDA
COUNTY OF F-, Lc3Ci
COUNTY OF
The forgoing instr ent was acknowledged before me
this {1
The forgoing instrument was acknowledged before me
ay of Ar 20J by
this _ day of 20_ by
Name of pers✓or making statement
Name of person making statement'-
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
'nature
o Not ublic- State of 1 r'
of Notary Public -State of Florida )
C mmission No. aor rr��{ Public State of Florida
HeBullers -
]mgnature
mission No. (Seal)
My Commission FF 118340
04125018
qa fpires
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DATE
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DATE
COMPLETED
Rev.8/2/17