HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 �G Permit Number: Otus- 1 5
SCANNED ERECEIVED]BY
$t. Lucie County Building Permit Applicatio
Planning and Development Services Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential 'A ,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ��,. -_ I
PROPOSED IMPROVEMENT LOCATION: .1
Address: ,506/ iL A2A At vaTN 3 V f c/i
Legal Description: (leis) -SOU- R
Property raX ID #: \ t� \ \.\ - (70 0 1- 6 G-00i d 00 -3 Lot No.
Site Plan Name:
Project Name:
Setbacks Fr
Back: Right Side: Left Side:
Block No.
I DETAILED DESCRIPTION OF WORK: III
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CONSTRUCTION INFORMATION:
itlona war to e e orme under tispermit-c ec a apply:-
QHVAC E] Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
11 Electric 0 Plumbing Sprinklers Elenerator 11 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 500 0. 0 d Utilities:[]Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1;ISC9A1Lt) LS J4
Name: �/2AC..7 ZIT47?'
Address: 506 / A✓ A,14
Company_ 9^ae,=A„ S�VS2n�IhEMAL [� /1E5Trridi
_
City: �D.14 HyTtNZ.v50N State: FZ
Zip Code: 3 9/9 L/I Fax:
Phone No. -Zo / 66 / - 511136 2
Address: 3oR SCRwQ o4x L
City: SA4145o..+✓SLc 6 State: C4
Zip Code:312 2 3 Fax:
Phone No. VY3- 8Y4;-1337
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: C 6C. /S/ y t? S 6
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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, congplt with lender or an attorney before
ST TE OF FLORID���.^ , STATE OF FLOg1B
C NTY OFV�C�AQ 2l COUNTY OF
The forgoing instru ent was acknowledged before me
thisvrAo a o� 20JL by
J W O.A.5 C
Name of person making statement
Personally Known OR Produced Identification
Type of Identification II�..
Produced P S lam z>L -
/ G • I Vu-e-a ttiJ
(Signat otary Public- State of Florida )
Commission No. t'r
"'�oL'a•.,
REVIEWS
FRONT
COUNTER
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
G FRI
C1ULIri9
The
day of
!me
ro,L l
Name of person Making stafement
Personally Known OR Produced Identification
Type ofldent catlQn I
Produced -,( WI V• 1 ,1 CJ!fft"l1t)e
(Signature of Notary Public- State of Florida
'c m ission No. —I .(Srea���. `R "i
VEGETATION WIMKGTG
REVIEW REVIEW REVIEW