HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONram'
1LL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: Zf / Permit Number: I Ooa• os3{-
m , : Awnoo along -18
• A8 RECEIVED
Building Perrrnt�`b' l cation FEB 21 1018
Planning and Development Services
Building and Lode Regulation Division Permitting Department
St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial v� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 13,c4 131v_1 Ff, p,,, . PL -3gfi
Legal DescriptiomLf Co2Yoru trium Gom0irSika ot- 6p,
6 Cc A7 ,, o/ze v .
Property Tax ID #: [LIZ S- %S-(, — 0000— 000 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: C0ASfcvc4- vl-cv rtimp I i« ciins llcelvlac, ejci:(b°-`/ 4,7/ rco— C1`Gc�- re�gct e
CONSTRUCTION INFORMATION:
Additional work to a er orme under this permit— check a apply:
EIHVAC E] Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
11 Electric 0 Plumbing Sprinklers 1:1 Generator . ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sct. of First Floor:
Cost of Construction: $ S �00 Utilities:n Sewer 0 Septic . Building Height:
OWNER/LESSEE:
CONTRACTOR:,
NameIly /-p[Lw7 on TGL Cc5 If 1—A 1m
Name:
Address: 3eSSr�' ccrdl�l I)r: 946 zoo
Company:
City: V (,-0 9CIC4 FG State: /1:4—
Zip Code: 329k 3 Fax:
Phone No.
Address: /� SF 74,uha3-fl�i�e
City: State: YG
Zip Code: '� �(�(% Fax: 7L 877-- V70e
Phone No. 7z) �7/¢
E-Mail:
Fill in fee simple Title Holder on next.page ( if different
from the Owner listed above)
E-Mail: %vq / C c — A�
State or County License: CGC /SZ yneo
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: CM
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address: 2ogl 5 —
Address:
City:
Zip: '3ali� fjPhone 72
State: FG
o
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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, consult with lender or an attorney before
commencing -work of recording vouGNotice of Commencement. ,
T::�g /��_
Z�Z�
Signature of Owner/ Lessee/C ntractor as Agent for Owner
_1�/
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF PIdV, 9,2"
COUNTY OF
The for oing instrum t was acknowledged before me
this/� dayof (e 20Aby
The forgoing instrumen was acknowledged efore me
this Ldayof 20i by
ost
Name of person ma(kin�g sta ement
Personally Known FOR Produced Identification
Name of person makin ement
Personally Known L,--�OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Nea ate of Florida
Signature of No Ic- tate of Florida )
s.•w TICA A GOM
Commission No. F?f' 'k;
:�i'''4e: AMER%( GOMEZ
mmission No. :'�:•
�+'ea�tijj
• M CO MISSION A FF2292
-
•_ MV COMMISSION M FF229261
-
EXPIRES August 01. 2019
''i•;,y;e�' EXPIRES August 01. 2019
r
SEATURTLE
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
q � r2
O��
Q.
RECEIVED
d••
tJ
DATE
_ _,/J
COMPLETED
(ice
Rev. 8/2/17