HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COW', _ =' 3 "D FOR APPLICATION TO BE ACCEPTED
Date: z Permit Number: 1 1 0 l 1 J I
-�4uno0 alon
----- -- _- 03N H,�,. RECEIVED
Building Permit Wpplllication
Planning and Development Services FEB 222018
Building and Code Regulation Division ST. Lucie County, Permitting
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 III
PROPOSED IMPROVEMENT LOCATION:
Address: /67919 S cip.S V //
Legal Description: h� �id2h15
Property Tax ID #: a 7�� �l ADO i%DC� " g' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK: III
/O
l 118%0 %/77 d&
dal.. 8
I CONSTRUCTION INFORMATION: III
❑HVAC LJ Gas Tank ❑Gas Piping
11 Electric El Plumbing []Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ Q ODD • OC%
Shutters ❑ Windows/Doors
Generator II Roof = Roof pitch
S Ft. of First Floor:
Utilities:0Sewer ElSeptic Building Height:
OWNER/LESSEE;
CONTRACTOR:
u odName:.
Name T/<ad",g / 6)A.)7A- t n',s okxl' '#ro
M
Address 1,079?4-99 S .S hfg&29) '
City: Aou-7 - S% 6e,E% A& J Sat te: LE�G
Zip Code: Fax:
Phone No. '7%a2— _ ®li
Company: Z 2�fZc 7Zts �J
Addresses: 22 7i SE %� /� e.
City: Pau-7-57- State:�F_L
Zip Code: VPS--a Fax:
Phone No. 'T%,?--a gg—
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: /MC,^g ve.-^d+liAl- J (G
State or County License: 'C A7C/fX?S9
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI= "" IEN'LAW INFORMATION-
DESIGNER/ENGINEER: V Not Applicable MORTGAGE COMPANY: _ <Aot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: V Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Zip: Phone:
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/ I"seelContractor
as Agent for Owner
Signature of Contradtf/UCerise Holder
STATE OF FLO", L `
A.
STATE OF FLORIDA
COUNTYOF
Ll 'le'
COUNTYOF �1C.tL
The forgoing instru was
acknowledgFAbefore me
by
The forgoing mstru s acknowledg%oefore me
this day of 20_M by
this a of
mAFIc . !2)P,"?,EV4IAW
20
WM ,
Name of person makWg
statement ✓
Name of person makThg statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identiflggtion
Type of IdentifioaIior
Produced
a1_
Produced i (. 0
I
01
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
...'e"••-
-Commission-No.—.`•r-=
KAR.E.N_�Sj�ELSEN_ —.Commission-No.
dd - --- -
""'.""%—K —
- -ARE
mission-a-F 115637
My Commission Expires
IE LSEN
Commission
3 •= N FF
MY Co mmission
For€+
•••bnpPp"
June 72, 2018
p•E or n�Ap` Exp56e7
—
018
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
A In
COMPLETED
Rev.8/2/17
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