HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-) a5 SCANNED
C N ED Permit Number: 1qol-a (ooro
RECEIVED
_ 7z St. Lucie County
'_____ _ _ _ JUL 24 2018
Building Permit Applicatibn
Lucie County, Permitting
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 ✓ Residential
VIR
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of li .
PROPOSED IMPROVEMENT LOCATION:
Address: tA) 1/ L� /)t• c� L�l �/
Legal Description: �rP,-�
Property Tax ID #:
Lot No.
Site Plan Name: , / Block No.
Project Name: 1AZ/I' U A
Setbacks Front
Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
- (I'
CONSTRUCTION INFORMATION:
rtiona Wor to e erformed under
[:IHV.A
tispermit-check
all apply:
GasTank
EIGa Piping
_Shutters
❑Windows/Doors
11 Electric ' 0 Plumbing
ESprinklers
1:1 Generator
Roof Roof pitch
Total Sq. Ft of Construction:
SC Ft.of First Floor:
Cost of Construction: $
WV Utilities: LJ Sewer El Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t)-ol
Name: ew&%
, (,44 4 In
Address:b'�i54-0
aec
Company: /^ �i
City: 16 ,Anti +.
Zip Code: '!;� d`\ Fax:
Phone No.
State:
Address: A 0 4,16
City: Roetc� State:_rL
Zip Code: _,�'LVJ '9 Fax: �7iZ��7iS u%
Phone No. -7- o Q `' • S
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: C((M_-q_mf� tr-r6G,L C,(Aa
State or County License: �_ fI� V3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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 TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Lice a Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of . 20_ by
The foJggoing instrument was acknowledged before me
this 14 d/a/y of
/Tw{[',tt�•i
REGOIVE�
_A
a
SUPPLEMENT[ CQNSfR(�CTION LIEN LAs t�
`ION cc x—
x_
DESIGNER/ENGINEER:
Name:
_ Not ApplicaIY
;; .
v UORTGAGE 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, consult with lender or an attorney before
..A, n nMing vni it hintirP of rnminnPrlfPnlPnt-
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Signature of Owner esse on ract Agent for Owner
Signature of Contractor/Lice a Holder
STATE OF FLORIDA
STATE OF FLORIDA A �����1
COUNTY OF J i
COUNTY OF / v' ' 1
The fprgoing instrument was acknowledgecl before me
'/K Kl' 11
The folgoIng instrument was acknowledged before me
this 0/4 day of J'WNI 26Y by
this day of 20{ by
WGl
Name of pen making statement
Name of pen making sta ement
Personally Known ✓ OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Prod a
Produce
S�A
— 4
'(SignaturetA
o Notary Public- State of Florida)
Signature of No ry Public- State of Florida )
Commission No. q—ZI —A (Seal)
Commission No. g21r / (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17