HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE
Date:
FOR APPLICATION TO BE ACCEPTED (�
SCANNED Permit Number: Ip Qb-Q4CD,=)-
BY
St. Lucie County
RECEIVED
MAR 15 2018
Building Permit Application Permitting Department
Planning and Development Services St, Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce F134982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED JMPROVEMENT.LOCATION:
Address: �720 (Vo r4h HWV l9lig Unilf-,30 J T-6 lPi ona-,j RL 39 L49
Legal Description: ly23 'S05 000k- 600- 86 — O C.e,6rn ?CO_,
(JO n CJ o rro; n j u f)
Property Tax ID #: N.9 3 - SOS"' lu)k wo - e�— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION, OF WORK:
(JQC).z LU l'F- Lk/ oe u; I1yl ,4 oti ; -Y � P G --
CONSTRUCTION INFORMATION:
Additional work to e orme under t-checkispermit a apply:
EjHVAC M Gas Tank ❑Gas Piping in _ Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers E Generator E Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ W i 1-7 &-' 00 UtilitiestSewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: • _
Name-%rs- -j3-rii)ti /=D �e;LC�oldman
►
Name: , +'
Address: it
Company: Window SG1rS
r
t Se.rVI�(Ai o yez-0
city: For`i ie-r'Cp/ Stater-
ZipCode:c3L4 9l49 Fax:
Phone No.5 (11 - 951
AddressZ75 L701'h ✓P)
City: Vero pJvGG11 State: FL
Zip Code: 3291aD Fax:S(D%- lL6
Phone No. -1% - i-3U5
E-Mail: C�(O Qohl, /11P,. WOh
_
Fill in fee simpf"e Title Holder on next page ( if different
from the Owner listed above)
E-Mail: W 1rltJ0W S(Ja
V 6eJK0
�,13e4-
State or County License: 3 JrFi�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SURPL-EMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
DESIGNER/ENGINEER: _
Name: ` —' r/etZ
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Addres : 8' 0
2—
Address:
City: in
Zip: 3195d' Phone772-589-
State: FL-
U229
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
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
cornmencing work or recording our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
SignatTre of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDJkp
COUNTYOF S+'k,
.n
COUNTYOFSi La,,p,
The foing ins ument
o�g
was acknowledged before me
The forgoing instr ment was acknowledged before me
this day of }
�J�2p6L by
this (�day ofy— / y� p 201LL by
Name of person making statement
Name of person making statement
Personally Known
OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced,
Produced({ (
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Commission No.
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DATE
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DATE
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COMPLETED
Rev.8/2/17