HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI*
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ALL APPLICABLE INFO MUST BE COMPLETED_ FOR APPLICATION TO BE ACCEPTED
Date: \% 1A CANNED Permit Number. yglo d3i
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BY
• St. Lucie County
- '-—
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
OCT 16 2h18
ST. Lucie County; Permitting
Commercial ✓ Residential
PERMIT APPLICATION FOR: To Select from dropboxi click arrow at the end of Iine-(�Yo,,
PROPOSED, IMPROVEMENT LOCATION: �I
Address: -')Or
Legal Description:
Property Tax ID#: q 00Lot No.
Site Plan Name:-1- A 1 kick No.
Project Name: I '(6GSUrtCO CK T- VK5, 1 (/it fit %y-n01 - S(
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
YYl Q h U 1Pr�i(�i) Shl �c, ` %(y o`LF r �p` i r Gym G(�'{ h
(b ►„Its '516"� IX,C11 4- �.�/�. I'l `����c D, c�f�I�
"Tr�usar� L v )
C6c�S7 T—h�::�i��j�r'! ' Gr t%At 3 1 °�' r18J1-c�S2C7 -t'o�,t�jar�
CONSTRUCTION INFORMATION:
UHVAC_ L-1.Gas Tank uGasPiping USHutters
Electric Plumbing ❑Sprinklers ❑Generator
Total Sq. Ft of Construction: C S Ft. of First Floor: _
Cost ofConstrudion:,$ d �60d Utilities:Sewef❑Septic
❑ Windows/D18ors
❑ Roof ❑ Roof pitch
Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name
c t
E (' r
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Name: C-
Address_: &CcCE
Company: Nil
S1, LS \-4-
city: r-a kG
Zip Code: Fax:
Phone No. d
State: (
Addre s: 3 S o-Q CE
City: G — State:
Zip Code: -1-T Fax: (o
Phone No. CEO 0
E-Mail: YA
Q tirgh r,)A 6KG (-11,:; Ok'A
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Fill in fee simple Title Holder on next page
from the Owner listed above)
if different
E-Mail: i dl
S i S , C 6m
State or County License: 6 S W 0 8 1 6 .
p YCIYC YI Ly'15o ucuun m;,zouu or more, a xewnuru Notice or commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIQN:
DESIGNER GINEE P.
Name: n
_ Not Applicable
MORTGAGE COMPANY:
Name:
CL Not Applicable
Address:
I
Address:
City:
Zip: 3ZIzA P ne
State:
2.6 7
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name: fi:c" arts.-
_Not Applicable
C o rY-I G vx!
Address:
Address:1�30b 1l/111�?2nS�
1 Wo�k—
City:
City:_ S0� «So is .
F\
Zip: Phone:
3
Zip: �•{�4a 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{ounty 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
commencing workor recording our Notice of Commencement.
Gr!
Signature of Owner/ Lessee Cony ctQr as A enirr,Ow.n_ r
�SignaYure 6ontrac r/Lj ense HolBar
STATE OF FLORID
STATE OF FLO q,
COUNTYOF q
COUNTY OF�.c(r tZLGt
The for oing instru nt wa acknowledged fore me
The fo oing instr ment was,cknowledge�fore me
this da ofED�.20y
this day of 6 sl 20�i by
Name of personpaidng statement
Name of person aking statement
Personally Known Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary c- S a e
CommissionNoPi7i0603-2- (Seal) ,,. N
p 6�0� a n Nafa 6/�S��eothnna)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW'
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17