HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O 'f SCANNED Permit Number: I %O� D �7 /
BY
f�. — .. , = . �- -- �� St. Lucie County
RECEIVED
Building Permit Application
Planning and Development Services OCT 10 2017
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:
Address: l Qn q 44
Legal Description: St-rd. 3 '.i 3 D:' O
Property Tax ID #: 424/III3' 0410, 02d - P Lot No.
Site Plan Name: o�n�'' Block No.
- .�.�(! f'.Ti., Project Name: Uw-t If I�q
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
01s—J1 csTit GQQc 5�o aJ 6� Q `
CONSTRUCTION INFORMATION:
ruunw uai wU,n w un cuui IIICU unuci uub pei Iui—uIecrt du apply:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
FiQr
LoElectric ❑Plumbing ❑Sprinklers ❑Generator ❑Roof ❑ Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ / DD.
59 Ft. of First Floor: _
Utilities: I❑Sewer ❑Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Na i
Name:
Address: 3 L DO
Company:- iZ�2CALl 0C
n
City: r A"Yd State:
Zip Code: �� % Fax:
Phone No. ?7-- 1165- 0477
n
Address: g,H7 d�94kA.YXq=
City:.!P Pc.a t ate State: 41
Zip Code: .32{9JJ(S Fax: ylo/-�?7-79'
Phone No%72• L161- -:;0•77 7
E-Mail:
Fill- in fee simple Title Holderon.next page { if different
from the Owner listed above)
E-Mai1:/)rikte`Gorn
State or County License: E= d /300 -S SS 9
e s
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN' LAW INFORMATION:
Name:
Address:
City: State:
Zp: Phone
MORTGAGE COMPANY: XNot Applicable
Address:
City: State:
Zp: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFtDVIT:Application is hereby made to obtain a permit to do the work a nd-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 inspectio If you intend to obtain financing, consult with lenderg�an attorney before
commencing work or r cor ine vour Notice of Commencement. /
Signatufecif Own er/ a ee/Contractor as Agent for Owner
Sign;itLrre of Contra cto ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
�!
COUNTYOF -t-LOS,LdlL
I-)
COUNTYOF )&J 4a.
The forgoing instru ent was acknowledged before me
The forgoing instrument was acknowledged before
me
this) O day of 20by
this JD day of0c-h5b.ee 20n by
Name ofpersoy-making statement
Name afperson-making statement -
Personally Known ✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
_ Ylz
(Signature of Notary Public -State of Florida)
(Signature of Notary Public -State of Florida )
DAVID RA
l
D PRUE /�
FF� 9aG7J
DAVID RAYMOND
Commission No.
LLCommissionNo.
WnARYPU13 X
&NOTARYPU
STATE OF R
ORIDA
ATE OF FLORID
Comm# FF1g,
wis
pymiN FF19W5
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17