HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
SCANNED
Date: �1 �-1 n BY Permit Number:
St. Lucie County
Building Permit ApplicatioAECEIVED
Planning and Development Services
Building and Code Regulation Division NOV 0 7 2017
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial2— R%4*AbPhQ-O)epactment
PERMIT APPLICATION FOR: P ll ` M """"`rr ' I III
To Select from dro box, click arrow at she -end a Itna
Address: /nS70 US oft)(1
Legal Description:
Property Tax ID Jf: _�Z//G/ ,SAD/ 4)7 f 3 3 DD 0 Lot No.
Site Plan Name: Block No.
Project Name: GOLD 6194,51— AzOckJAZ C/Jee))T LIRJJ0A1
Setbacks Front Back:
Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
&V Ail .S/SN
CONSTRUCTION INFORMATION: s III
HVAC L_J Gas Tank
Electric 0 Plumbing
Piping
Sprinklers
Shutters ❑ Windows/Doors
Generator 11 Roof = Roof pitch
Total Sq. Ft of Construction: &/`i S Ft. of First Floor:
Cost of Construction: $ Q utilities. Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name /D S Ito .R10a.1 T'/ CL C
Name: F(3D&h/ J"VXyS
Address: / n C 2 0 .S v S &AAe
Company:
City: RSA State: E?
Zip Code:.9 i/ q. 2 Fax:
Phone No.
Address: 9y,� .24 721 JX_
City: lw/PB _ Stater
Zip Code: 3 ? t10 7 Fax:
Phone No. S6/ FOB
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: d /nR Yid �FiPrP/�. T7�/JS. <0/N
State or County License: 4'—f p000 /yv
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 thepermitholder 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 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 with lender or an attorney before
commencing work or recording your Notice of Commencement.
ature of Owner/ Lessee/Contractor as Agent for Owner
Sigpkfure of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF (%a lert /St2G(n
COUNTY OF eP4a zkc y GL
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 3,,_ day of 6cfeyrlt 20 f 7 lL
this[,Z day of 0CA4n6 d_ 20 i7 b
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Name of person making statement '.
p
Name of erson making statement
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Personally Known � OR Produced Ide fic§E(g;•
Personally Known OR Produced Identif
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ate
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Type of Identification a
Type of Identification
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Produced
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(Signature &I N6tary Public- State of Florida S r _
(Signature of otary Public -State of Florida)
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Commission No. (S J! r
Commission No. (Se
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
/Z 7
COMPLETED
Rev.8/2/17