HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLEE/ INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f Y
Date: �- 12- 18 SCANNED Permit Number:BY
St. Luce County LRECEIVEL
Building Permit Application APR 17 2018
Planning and Development Services
Building and Code Regulation Division mitting Departmer
2300 Virginia Avenue, Fort Pierce FL 34982 UCie County.
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ReFL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENTLOCATION: pieC£Address: gR82- fgor iKngs oku)Q FL 3tgs` `
Legal Description:
Property Tax ID #: 1323 - Z3 Z -Obo 1. OOO- q
Lot No.
Site Plan Name:
Block No.
Project Name: QM D n, Y4.i- 4160_pp 't
Setbacks Front Back: Right Side:
Left Side:
DETAILED.DESCRIPTION;OF WORK:
FA
f idr)C 15.51- 2u.11 TV oola�) 1z) Exv' I...)
awf.A� -
; AD `
Vbr-e k' Df r
CONSTRUCTION 1NFORMATION
Mona wor to e
0HVAC
e orme under t-checkispermit a
Gas Tank E]GasPiping
apply:
Shutters
❑Windows/Doors
_
11 Electric 0
Plumbing Sprinklers
Generator
ID
Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2. 40
S'c Ft. of First Floor:
i
Utilities: Sewer Septic Building Height: L6 M
.Si on cjeea_Yh h�
OWNER/LESSEE.
CONTRACTOR
Name7J-6
furl S
- C 111 (aSS-I£f
ame:
n
Address: S,11( urns ICI c f\flpr IUCS d'b (91
Company,��
S
' 1
City: State:
Zip Code., Fax:
Phone No.
pV Address: t J2iC
City: eslour
Zip Code: 3
Phone No. ? 5a-�<-
Fax:
t (0517
State:kL.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Li
_
A
/1Ss, OM
State or County License: CS 12
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. °) q S 71 (I
SUPPLEMENTAL CONSTRUCTION
La IOWNER/
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 o the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an a ne before
commencing work or recordin our Notice of Co encement.
D
1
Rev.8/2/17
LIEN LAW INFORMATION
DESIGNER/ENGINEER:
Name: {L
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address: l
Address:
City:
Zipti�.t7d.5 Phone I.3gla•'1
Stater
y Scff 9
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
of Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ Lessee/Contractor as Agent foS wn
ig re o ntractor/License Holder
STATE OF FLORIDA
ST E F FLORIDA
COUNTY OF
O TY OF LA-IG�
The forgoing instrument was acknowledged before me
The f going instrument was ackn wledged before me
this _ day of ,20_ by
thisj�d/ray��of
I SUPPLEMENTAL CONSTRUCTION LIEN !LAW INFORMATION:
Not Applicable I MORTGAGE COMPANY:
City:
Zip:.
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zio: Phone:
Address:
Applicable
City: State:
Zip: Phone:
BONDING COMPANY: 'Not Applicable
Address:
Zip:
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 ed and posted on the jobsite
before the first i n. If you intend to obtain financing, cons it le der or an attorney before
commencin ork or retording vour_Net:ice of Commencement-.'
FLORIDA
OF
The for oing instr ment was acknowledged before me
this day of 2012� by
—Y n
Narhe of person,�king Statement
Personally Known ✓ OR Produced Identification
Type of Identification
of Notary Pu lic-State of Florida�r Loletta H.IL
n No. GG I�Ul7yi �o NOTARY F
STATE OF
` ? Comm# G(
REVIEWS I FRONT
COUNTER
DATE
Rev.
OF FLORIDA
fY OF
The forgoin ginstr ent was acknowledged before me
this da of 20Jb
Name of person ma mg staMement
Personally Known I OR Produced Identification
Type of Identification
Produced
No.
Public -Mate NOTARY PUBLIC
14. ,� 5STATE0FFLORI
Expires 5/2/2021
ZONING EATURTANG
REVIEW S REVIEWUPERVISOR I REV EW I PNSV EVI WEGETATION S EV EWLE I M EVIEWVE