HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '3�--"611 %4 SCANNED Permit Number:
BY
St. Lucie County RECEIVED
Building Permit Application MAR 2 0 2918
Planning and Development Services
Building and Code Regulation Division ST. Lucie countyt Parmltting
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 C o v4a
PROPOSED IMPROVEMENT LOCATION:
Address: ciWD S. oemn Jhyt� Ur)Il; IFJ02.
Legal Description: 'Fmpycsj itQ_j2('{omiYI1urn IAnii I502 '
Property Tax ID #: 4502-- (020- QIIO' (M- I Lot No.
Site Plan Name -The ErnfprPO,C Concio Block No.
Project Name: �_KQ tan R
Setbacks Front Back:
Right Side: Left Side:
I,'DETAILED DESCRIPTION OF WORK: EYjS} nQI \ JJCYC S n PCr[jJ1 I111-COB5 111
_Remove and replace u2) Single hungs , (Z0
slidil�g 91ass doors and (i) antyY door
CONSTRUCTION INFORMATION:
itiona wor to e erformed under tispermit-check all apply:
�HVP Gas Tank ❑Gas Piping _Shutters Windows/Doors:
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor: _
Cost of Construction: $ 10 �� ' Utilities:cn Sewer E]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
n -Name 1c�u1SP KCIbrQ- --
-Name:lYir)1('I
I (?pit�iP
Address: q'{C(!O,9. 00foy) -I)Y. Llhi L�:D2
Company:_
lo(iQIS
City:, Imsen-Bm(h, Stater
Zip Code: 34cff� Fax: N 11%
Phone No.�(nl-3l5'G'lve(A
��YQ�P1,
Address: 3�� SE .LEIXI Q
City: Seta o V +
Zip Code:',-z1 ia7 Fax:171-2g(o-OL1SS
Phone No. _17a1' aB(0 -
State: FL
at-1 r,) Q
E-Mail: L+Ka I l
Fill in fee simple Title Holder on next pa a (if different
from the Owner listed above) -
E-Mail: pC'Y ll-YF�. Q10 S4
State or County License: Q r
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:
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
improvements7insp
r prope.rty. A Notice of Commencement, must be recorded and posted on thejobsite
before th sttion. If you intend to obtain financing, consult with lender or an attorney before
cons cing wrecording your Notice of Commencement.
gnature of O ner/ Le ee/Contractor as Agent for Owner
SignatLirafoontra—ctor/tTcensHolder
STATE OF
COUNTY OFORIDA mr i n
STATE OF FL
COUNTYOFORIDA
The forgoing instrument was acknowledged before me
The for ping instrument was acknowledged before me
thisaLLdayof F / rr*2018byL_OWSe
thisal dayof 20)?)by
KoLKan
T
Name of person making statement
Name of person m ing statement
Personally Kno n OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Produced �,
Type of Identification
Produced
1 )L
(Signature of Nota
rl KELL WSDMe
(Signature of Not a u ,
NfE6 I®ff
flp, ,
Commission No. � 4 Notary P 5q of Florida
929255
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Commission No. � ,'� r n r f® 02 Florida
i N0offififlo Cg�g��
Commission # FF
My Comm. Expires Oct 20, 2019
a ' My Commis 99P fs� ®01 g®, g®1SI
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7 NtId N®mfY
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Rev.8/2/17