HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONT
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I o� I I g l I i ermit Number: )l O
0� SCAgNEB
25
n =e
st. Lucie County RECEIVED
Building Permit Application
Planning and Development Services FEB k2018
Building and Code Regulation Division ST. Lucle county, permittir
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
I PROPOSED IMPROVEMENT LOCATION: I I III
Address: Q .m on
Legal Description: Ess oonri)m* I in It 3OLl-
PropertyTaxlD#: 45Ca-1naQ—MI?�-CM-I Lot No.
Site Plan Name
Project Name:
Setbacks Fr
int Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: -
emov� and rt_-p)i ac e (Q> Non - Irn Par-+ SSD's
C uLsionne - has CXI s+in9 sh u. Hers 'PCr-M i ►� ► - OC�4
CONSTRUCTION INFORMATION:
Aaartional work to e e orme under this —checkpermit a apply:
E1HVAC be
Tank ❑Gas Piping fn Shutters 1z Windows/Doors
11 Electric E] Plumbing Sprinklers E Generator E:] Roof Roof pitch
Total Sq. Ft of Construction: Sq. of First Floor:
Cost of Construction: $ 00 Utilities:Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name RacpName:
nt ) I l_n P pbe
Address: Ql=S-
1'(]Pl�r. Utl)•I" —703L
1
Company: -The CWq'Pr,!ReM1 C]I�
City: • lenses D4=nc1Y-)' state: 1-
Zip Code: 22)4g5-1 Fax: N I R
Phone No. 2M-'7Rq' *-�7d3
Address: zgfln
City: �isi u,tart State
Zip Code:eS4qq_1 Fax: -17a aA(c,-nkAbl
Phone No. `-7a-3-18(n-046g
E-Mail: +H-tV1PQQI_GX0
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or ounty License:
If value of construction is $2500 or more, a RECORDED Noticd'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 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 reviewyour 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
commenf;_mR work or recording our Notice of Commencement.
Signa of Ownerl Less a/Contractor as Agent for Owner
Signature ontractor/License Holder
STATE OF FLORIDA �pp
STATE OF FLORIDA 1 (a`
COUNTY OF t�'Lra,irEl > l
COUNTY OF f'1
The forgoing instrument was acknowledged before me
The fo oing in ument was acknowledged before me
this J�day of� i.20Aa by
this9dayo�CPJMOPK .20JJ by
'1`�Sicl LaQe
LrLpro
Name of perso aking statement
'laoic9
Name of perso aking statement
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification ,
Produced
Produced
Q00 _7f, o iclM -Nu
CV
0UaUW11LW
(Signature of t9tary Public- State of Florida j
(Signature of Notoy
u ic- St to f lor'da
,e Notar u
•,`o`"�"v"d��, r�ICEY WIDMAN
Commission No.
.., nr>"'..
Commission No. ' (5Etil)NIDMAN
• • -State of Florida
+ •: Commission # FF 929255
, o"
Notary Public - State of Florida
+?.' My Comm. Expires Oct 20, 2019
: •_ Commission # FF 929255
?y +:
'•����"
Bonded through
National Notary Assn.
�'''°f
Sh`d� Bondedthmugh
National Notar Assn.
0 I
REVIEWS
FRO T
PLANS
VEGETAT
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
dG
Rev.B/2/17
JOSEPH E. SMITH, CLERK '11L'. THE -CIRCUIT COURT - SAINT T*?^,TE COUNTY
FILE # 4400410 OR BOOK, 196 PAGE 1425, Recorded 02, 0`2018 03:25:15 PM
16 1,� O L7 r0 robe completed when constructfon vofue uceeds$2, ao.eo
PERMITS: rAxFOuoA 4ffQa- iaaan-0013-003 -1
STATE OF FLORIDA
COUNTY OF MARTEN
The undersigned hereby gives notice that improvement will be made to certain real property, and In accordance with Chapter 733, Made
51atutm. the following Information is provided In this Notice of Commencement
OESCRIFI'fOry
•
OWNER INFORMATION ORIISSEE INFORMATION, IFTHE LESSEE CONTRACIFFD FORTHE IMPROVEMENT:
Name: Kf1E'P1'1 CFrtfllln
Address: QlnM C Ofeny% DY (in 11— —Ana 1Pf)QCn t!:en
InterestinpropaMV: eml'1P.r
Name and address of fea simoia tide hnlderm dufarent from Ownarlistod ahnws�
SURETY COMPANY (IfappGtable, a copy of the payment bond is attached!:
Nameandaddress:
LENDER'S NAME:_
Address:_
Persons w'ahin the State of Florida designated by owner upon whom notices or other documents maybe served as provided by5ection 711 IR
(1) (a) 7, Florida statutes:
Address:
In addition m himself or herself, owner designates of ro
receive a copy of the LICror'S Notice as providad In Section 713.13(l)(b), Florida Statues.
Phone number of person. or entiry designated by Owner.
Expiration date of Notice of Commencement:
(the expfradon date may not be before the completion of construction and final payment to the contractor, but Will be 1 year from the date of
recording unless a different date Is so edged):
Under penalty of parjory, 1 deElarethat I havefead the foregoing and that the facts in it are true to the best of my knowledge and belief.
e�
Signature of Owmat'or Lessee or Owdefs or.*pIwe SAuthod:ed OffaerJlhrector/Partner/Manager/Attainey-in•fact
ii i.UY1 L•t' /
5lgnatory's Trd001ftce ,,
Theforegoing instrument was acknowiedged before me thfs-Lq-CLL,, diyof—Decernbe`/ ,Q.-
By: Ry: 'K I S- ei 111L1—as own in, for urn 5enatl4 _
Name of ersonu of author p Type 'ty (e.g.(C.g. offer, trustee) Party on behalfaf�vho:nJastmmcnt was ezeoned
f^,� 17 r I.
.-'L2�'V Personagyknown _�orpmduced AenL'ficatien -
Nomys Signetul j Type of identification produced
(Prin', Type, or Stamp Commissicned Nama of Notary)
T.',BLD1Bldg, Fo=k.Now AoplicatianslE'mmstNotiee Of Cammeieemcra.Doex
RECEIVED
FEB 13 2010
permitting Department
St. Lucie County
Rev. 9115111