HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR sP!RRLT TO BE ACCEPTED {X� ]
Date: BY Permit Number: I U �C Outj
Ls, Y` �� _ I St. Lucie County RECEIVED
—_- _ __•_._ _ _ -- JAN 12 20i8
Building Permit Application Per ittinJADepartment
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address:
Legal
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front Back: Right Side: Left Side:
PROVEMENT LOCATION:
7U N.
14-1gl4LVS - 13V' iZfm' - 594or 1
114a3-0057-000-7
Lot No.
Block No.
IIDETAILED DESCRIPTION OF WORK:
8 t44W47- Cxts�n/L? WI N O ��✓5 I l�biTCS . �aF�sol+r c✓ g't F
HVAC L—JGasTank (JGasPiping L_IShutters L(Windows/Doors
Electric 11 Plumbing Sprinklers 11 Generator 11 Roof = Roof pitch
Total Sq. Ft of Constructi n:
Cost of Construction: $ 6
S Ft. of First Floor: _
Utilities:ll Sewer E]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name OAIV
Name: w ,tM
Address: 597V N 004 QbYS
Company: ftOMte-t..12 IGIQO.tn.l- u-r !22�
City: CCAtt ll�di6/tQGG State:l_t
Zip Code: 3 Fax: A/�14 _
Phone No. a�(L/ - 676- 5737Y
Address: � (J?j-4 F- iFLK W �f2
City: 1686 SF!_l-t- State:f�L
Zip Code: Fax: oZ t -7— q C yy
Phone No. i `7
E-Mail: - ii108SOPVVQ% %&q:1Wd • Cam.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 91S <F ACI✓9 . Vr� s,T—
State or County License: CQC' O oL 3 8,54
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:
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, consult with lender or an attorney before
commencine work or recordine vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this_ day of , 20 by
S
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of
20 _by
1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public -State of Florida) (Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
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ZONING
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MANGROVE
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INITIALS
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Address:
MORTGAGE COMPANY: — Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
Zip: Phone: I Zip:
—Not Applicable
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, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF_Sh_ LOcNe
COUNTY OF //Idlon �I✓�/ ���
The forgoing instrument was acknowledgei before me
-5
The forgoing instrument was acknowledged before me
this _14 day of A rs , 201 by
this 16 day of �,i acz C4 201 � by
�o-rs0.\d kCa-..V.d%') 4
Ronaio( K/-or" y-ayf—
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification f/
Type of Identification
Type of Identifi tion
Produced E L 1) L
Produced
^�
••�,°'•'"ge�,s YESMINA P TRAUR911
(Signature of Notary Pu lic- State of Flor'
p. NAMARIEGIVENS
ign ure of otary Pu _ S f raM ° -
y �� . 0 m.ExplresApr29.2018
Commission No. Q 5 �" °"''`• c
"`/F'•c SSt�� +AIdISSiON#GG 022023
mission No. �' ;' COOrmisiion I fE 115t100
- EXPIRES: December 16, 2020
R;7 BoodedThm Notary Pubic Undenml
rs
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17