HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11
Date:
SCANNED 7
BY Permit Number:
Im St. Lucie County I RECIEVED II
Building Permit Application OCT 12 2017
Planning and Development Services
Building and Code Regulation Division Permitting Dept. St. Lucie County, Fl.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address: 1(Ooo S bcect n Di2 Unit 205
Legal Description: Cmp reS� o M I h l () m U Y) i t %D-c--,
Property Tax ID #: 4502- (OW - 000 - QCO - d
Lot No.
Site Plan Name: iL Mpy-,r ss %Ur) 1p
Block No.
Project Name: SVIV-1 tm I?iS1dPn (X
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
?_tYV10V.e 4 RePIC(C-C C2) XM?CA t Str,51e V\Uh Vj)n60S
(Z� NON-IwPOV shchri5 TQSS dcnrS, C,w
ustan-w�-
haS tMSJ Ir1.S Sh\AVr_rs .
CONSTRUCTION INFORMATION:
Additional work to e oertormed under tispermit-check all
1IHVAC Gas Tank []Gas Piping
apply:
Windows/Doors
_Shutters
11 Electric 0 Plumbing Sprinklers
Generator 19 Roof
Roof pitch
Total Sq. Ft of Construction: Sct.
DD
of First Floor:
0Septic
Cost of Construction: $ �'� ` W . Utilities:I]Sewer
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Moirlig,
cy mariP,, g1/10jjZn
Name: David LCiproialf
Address: 5(o0D S. l�(.011iVl QV �Ilt 205
Company:I (rIAS5
FroftS510na%S
city: 04y1Sfn BtaCh State:_.
Zip Code: SLi 9 51 Fax: MI A
Phone No L-1-1Z) 229 - 7824
Address: �)51D SE Pix1-e
HWY
City: Ska rl
Zip Code: iGl�-1
Phone No. (__712� 'Zq(o-
State.
Fax: Z_%_62 -D410 I
0459
E-mail: ja b rrar►r'i bums, Q a+'r. Y10.+
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
S f
State or County License: 1017
b 73
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _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 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 insperrtioq. If you intend to obtain financing,,pensu4twith ler)kr or an attorney before
as Agent for Owner
STATE OF COUNTY OF MA
STAMA t1Y1 COUNTY TE OF OFORIDAmart(n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _'I_ day of nCt 20J] by this �i day of DClt 20J -1 by
tOM61 LcxlYod-e DOV1,61 LG MOk
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known �—OR Produced Identification
Type of Identification Type of Identification ,••�rirr
Produced /In )1 > Produced ��•• r, LOA j
••%`qu�p uNp4' :� r'' t0.6ir:
n.r i...., �•••r�} 1i :�1 1 Y ' J�,v�•�-, 1 \ (' J it ^ 0 TA
(Signature of Notary Public- State of
Commission No.
REVIEWS
Rev.8/2/17
FRONT I ZONING
COUNTER REVIEW
_• -4
pUBLic
REVIEW
of Notary Public -State of Florida )
(Seal)
i PUBL
) •.� qj �232
OF 40�� FI
PLANS
REVIEW I VREVI WON SEATURTREV EWLE I "" EVIEWVE