HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST
Date:
PLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: �� (1 ' Ouaz
SCANNED
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
NOV 2 7 2017
PERit. 1TT161..,,:
Residential st. Icie ccunty.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENTLOCATION:
Address:
Property Tax[ \: 3 ' 1(S-1 O `-� - 001(0 -U
Site Plan Name:V_Q i__alnno
Project Name: ;5bNN V ark nl�)
Setbacks Front Back: Right Side:_
Left Side:
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK:
S (P I cL-�, Ho () ` sUA/n 11
CONSTRUCTION INFORMATION: �l1
HVAC ❑Gas Tank ❑Gas Piping ❑Shutters ❑ Windows/Doors
Electric -� Plumbing Sprinklers ❑ Generator ❑ Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ °ay 00
S Ft. of First Floor: _
Utilities: O Sewer D Septic
Building Height:
OWNER/LESSEE: I
CONTRACTOR:.
Name mc c)
Name:
V-Cj n
Addre -1 Qy
City: VI0 W U Sta
Zip Code: yq'�K 6 Fax:
Phone No. -i W to
Company I IZ on ylIimhlnl�
Address:ya UnQUA 0
Ci State4X
I
Zip Co e: Fax: 1 33(o a
E-Mail:
l
Phone Noll a (o rj
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
I
State or County License: CFI
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALGONSTRUtTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
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.
no representation that is
e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 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 vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License H er
STATE OF FLORIDA
STATE OF FLORI�A
COUNTY OF
COUNTY OFF
The forgoing instrument was acknowledged before me
The for oing instrum4�nt was acknowledged before me
this _ day of 20_ by
this` day of S lJ .20 /% by
Name of person making statement
Name of p s making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identificati n
Produced
Produced
/iGCLf
(Signature of Notary Public- State of Florida)
(Signat a of Nota blic- t .ri
� ryPuMlc - state ofFlaida
• •- Commission 0 GG 099801
Commission No. (Seal)
Commission No. 01 t�g@go.FxPtresMay l.2on
•,. °,`,f`,....: Bwdedovough NEdenaniatarykm
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17