HomeMy WebLinkAboutBUILDING PERMIT APPLICATION4L
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: Mos.
BY
rr St. Lucie County 033�
Building Permit Application RECEIVED
Planning and Development Services MAY
Building and Code Regulation Division 1 Pe 2018
2300 Virginia Avenue, Fort Pierce FL 34982 St tLn a eoartment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential county
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED -IMPROVEMENT LOCATION: "
Address: -S 114
Legal Description:
Property Tax ID #: Z7/ f�� U 0 0( — 0 no/
LII, s
Site Plan Name: a F)LA)
Project Name:.S/�d"4
Setbacks Front Back: Right Side
Left Side:
I'DETAILED.DDEESSCRIPTION'OF WORK:"
CGy /✓Ll ll���/ Conf,4n)v SiX r% ex7, %e T�
ei'�ii 171gekNVS. /
I CONSTRUCTION INFORMATION: "
Block No.
2HVAC 0- Gas Tank ❑Gas Piping uShutters Windows/Doors
L✓JElectric _Plumbing �Sprinklerb� Generator c/ Roof Roof pitch
Total Sq. Ft of Construction: U , 5 Ft. of First Floor: I y�
Cost of Construction Utilities: Sewer LISeptic Building Height:
OWNER/LESSEE:
'CONTRACTOR:
Name % LC
Name:-
Address::13 a C'6K <- 2' 6
Company.:�l i "+ 1n1H2 kf 4b i
City: P � State:
ZipCode:33� Fax: S��'byl�GS��
Phone No. P612-c;�
Address: 2700 5.
City:l�T' Plc/le State:PL
Zip Code:?LJ9cis Fax:
Phone No. �7 F- 1/3e)
J I • Ca`'r
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Wei S FA/i.S0- /69, ao(• C"Al
State or County License: C-DCO5-p- r'o,3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUP,PLEfVIENTAL CONSTRUCT10hI LIEN LAW`==INFORMATION
..
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
R�ervEo
Name:
Name:
Address:
Address: Mdv ,
City:
State:
City: V 0 State:
Zip: Phone
_
Zip:
Luc
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 1 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 OW R: Your failure to Record a Notice of Commencement may result in your paying twice for
improve m to ur property. A Notice of Commencement must be recorded and posted on the jobsite
before th fir t i pection. If you intend to obtain financing, consult with lender or an attorney before
comme cin or recording vour Notice of Commencement.
of Owner/
as Agent for Owner
Holder
STATE OF FL IDDS� STATE OF FL DA
COUNTY OF Mm �0" COUNTY OF Cr-\ r L-1
The f rgoing instrument was acknowledge before me The forgoing instr ent wps acknowledged before me
th/is�dayof( 18'by this,;;2(pday of it 204Q by
of perso5,making statement Name of person aking statement
Petlsonally Known OR Produced Identification Pe on illy Known _�tOR Produced Identification
TYp of Identification T e of dentification
of Notary Public-
#GG
of Notary
2021
Commission No(-ml U_ '"I5eYFFrmes juna zb, zurt Co ission No.C�-lU' `' ''%°"; aUN Notan'Rbku
•�o�(�$"•:' ='I'd lw Notary ftkU
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW qEVJIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17