HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c1 L
Date: Permit Number:
rs ' L arc' -�-- - RECEIVED SEP 2 71017
• SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia 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: I?I
Address:
Legal Description:
L4_
e
qs / iom D xt Lor // (' o2orl 1149- 1134 )
Property Tax ID #: Lot No. SG 11
Site Plan Name: Block No.,�
Project Name: 3 � 600 E-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
P 2a'l Ov e o lct 00 -Brio- e4' —,r n S all tv-e W r2.e t, _13 9 r6eP,
r44-r rl J
ON INFORMATION:
LIHVAC U Gas Tank Gas
13 Electric 0 Plumbing
2 �Spr
Total Sq. Ft of Construction _ �T/4AGO
Cost of Construction: $
Piping
Generator
S Ft. of First Floor: _
Utilities:Sewer ElSeptic
Windows/Doors
M Roof ff r /2 F
r'Gcq -r
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name O6eZT- O 14 6 9 E C`e
Name:
ACoAJ
Address: .ago 4wy i
Company:5' &Ae"^_5
N tie XGRWO
City: r'&/RCP State:_o
Zip Code: 3C/ 9 $Z Fax:
PhoneNo.^%%Z 359- Y%Yf l
Address:�%DX10 65W0cl) ID
City: LPG PQ State. —Et
Zip Code: 33W ? Fax:
PhoneNo. 6-91 S%q Z% S) 8
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: a '5W&R&�14W ed
fJPe1z6i /Tsuw •
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State or County License: (l 6 C
60 4'8 y3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: .
DESIGNER/ENGINEER- ,y /
Name:/A"/ /
Not Applicable
MORTGAGE COMPQNy: , /t,
Name: /�J UPI
—Not Applicable
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDJR;
Name:
Not Applicable
BONDING COMPA jf: r _Not Applicable
Name: �/
Address:
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 County makes no representation that is granting a per 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�ender or an attorney before
commencing -work of recording vaur Notice of Commencement/
Signature of Owner/ Lessee/Contractor as Agent for Owner
r Cdntractor/License Holder
STATE OF FLORIDA
S?'LK G
STATE OF FLORIDA
COUNTY OF e 1°
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisday of SC?PT 20�by
this day of jOT 2017by
�o6P427— eallo(?PiUrn-v_-_
o(2 JaR )5ACo/J
Name of person making statement
Name of person making stgAirient
Personally Known 0 Pr d ced Identification
Personally Known _7�� OR oclucO Identification
Type of Identification
T e of Identi i ion
Pr ce
Produced '
�
1
'(Signatur f a Ine late of Florida;
(Signat re of No Public- Late of Florida )
Commission No. �p4 '••`�' DEED
om N0. r'• 0E AN
sslont 11SZ90
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17