HomeMy WebLinkAboutBUILDING PERMIT APPLICATION5� Cie_ Co. i)id + &ldm av-c-C4
ALL APPLICABLE INFO MUST BE COMPLETED FORiAPPLICATION TO BE ACCEPTED
Date:
SCANNED
Permit Number:
,..,a, to
�iall BY. RECEIVED
St. Lucie Colint
Building Permit application JAN 10 2018
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
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: -3011 CAt'Anrry- aVf r+.Pi-CfCC, ]L, _-;5496L
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: 'a ( Lure CO. (�( + �tidQ jgi!! (bt
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK.
R-cy-cup I IP-10+ lr�
kONSTRUCTIONPINFOAMATION:
Lot No.
Block No.
Aaanionai worK to De errormea unaertnis permit-cnecK all apply:
❑HViA Gas Tank ❑Gas Piping _ Shutters ❑Windows/Doors
❑Electric El Plumbing I_ []Sprinklers ❑Generator Ejj 1� Roof 4�i IItboyy.
fpitch
Total Sq. Ft of Construction: �D.� s Ul S Ft. of First Floor:
I 1
Cost of Construction: $ L-ra, Sob ,OU Utilities: Sewer ❑ Septic Building Height: 17--
`'OWNER/LESSEE:
CONTRACTOR" a
Named Al r le lj�
\L
Name:
Address: 2 1(X\(((QjrIIC(
(2tve
Company: Th'YnnQ '01 R112P
&J6JCMSLV
_
City: . PI-P_YC _'J State:_
Zip Code: 3'}Q 2-Fax:
Phone No. 113 4LOQ - l s7 3
Address: 147_I
)C'iyx
City: LOP15
Zip Code: 3BL *Y- Fax:
Phone No.'301- 7Z_-3-7X9I0
State:-F—L
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: SRIVr->(0+VU-A MQ Sg1I
V-M% Lmy)
State or County License:
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 TITLEHOLDER: _ 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 -inspection. If you intend to obtain financing c t-withJender or 3� attorney before- - -- -
commencina work or recordine vour Notice of Commence nt. ,, �� 11 /I // //
X
' nature of Owner/ Lessee/ebntractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDI
COUNTY OF �� �f�t (I 1
COUNTY OF_fri'A ( YY) kiff r h
The forgoing instrument was ac nowledged before me
r
The f ing instrument was acknowledged before me
t s ay of Jon-k 20 It by
this, ay of hhU(JfQ _ , 20a by
le-alL,11aK ]QG1i'L
vP r Il, If P. I,
e of person making statement
Nam f person making statement
Personally Known OR Produced Identification,/
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced EA_ nL
Produced .......
JASMINE RIVERA
JASMINE RIVER
ke Commission AGG 8456
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Commission N GG 64
My Commission Expire
67 °+ 4u1�dF'- January 22, 2021
(MignattWe of Notary Public-�fa(� , `rida yonuary 22, 202
(Sig to o ary Publi - a o n a
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Rev.8/2/17