HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S Q..fY jt alof f IS, 2o1B SCANNED Permit Number:
BY RECEIVED
ML
f Lucie County
Building Permit Application OCT 1 6 2018
Planning and Development services ST. Lucie County, Per
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line $vsL�s�L(s III
ENT LOCA
Address: 4500 "-) OLPAvi 1�.""10;l-
Legal Description: T5tn.A_ia [I ConAoHwt%uM uy\�k 1�� (oQ 1454'1501�
Property Tax ID q: `rl L l IJl Jz (' J�' G /l /� Lot No.
Site Plan Name:
Project Name: ,J Y)C w bza(A, 3�'P c't"
Setbacks Front Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK:
i"�6M4A �2f..Wti1ioV�� i)QiinroDM s ILitc,Rtw ut-xbawin; At 4.44., 1g51ead op tj
Kit -Coen Rj .('a.�" i�; lieflLt-fl J new lileS SUrraU�U !h 6a1hro°r�� nP�
U)k Nrcs ' e.4vey-fIwh-(66 �S60606 `)r liew vlfni 1h Cioiroo
CONSTRUCTION INFO_ RMATION-
tt�ona work to e e orme under t-cheekispermit a apply:
❑HVAC 11 Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing [:]Sprinklers❑ Generator ❑ Roof ❑ Roof pitch
Total Sq. Ft of Construction: jnno V* S Ft. of First Floor: _
Cost of Construction:$ ID-,�00 Utilities: []Sewer❑Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name -Tiq, Y irdG nO.F2C
Name: t-ILCLV&
t�tbcko.
Address:'ICoO S oL_ear, L7C
Company: ills 4 lotylUA,1 (pnS (16Y\
City: i D[-+ S+- Luc- C. State: i'L-
Zip Code: 3 49 5 ,�_ Fax:
Phone No. 31 4 - ?�=), 4 — Ig2 %fo
Address: 0101 auJ 'l(ak(. ItyVaLe,
City:.Fo✓k L6Vd2Vd 4j 2 State: flu
Zip Code: 3331 :31r Fax:
Phone No. 954 -a k4 - 9-(o 2-S
E-Mail: T is4 _ 14, (d LI QhOn . r nra
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: t Fbtaaanct&l. • LOM
State or County License: C LsC. i 5 ,QL45d 5
( !h
knell
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or angcovenants 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 record d and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lerifer or an attorney before
commencing work or recording your Notice of Commencement. i ///
Signature of Owner/ Lessee/Contractor as Agent f4,dwneiSignatu
a of Co tractor/License Holder
STATE OF FLORIDA 11
STATE OF LORIDA
COUNTYOF gJ�afw�/
COUNTY43F IS✓1a�Jo
The forgoing instrument was acknowledged before me
The forgoing instrumen was acknowledged before me
this I day of [ 9c o lo-cr , 20�' by
this day of c ho Io c V 20— $ by
Name of person makirig statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary•i
•' IC °LRAMIRQ
(Signature of Notat • , IC
t MICHAEL
isb " gip• RAMIREZ
Commission No.
-•: •• MYCOM�gS�IQN#GG 169200
.'•'aii.
Commission No. •- :•; MYCOMMIB�@ GG 189200
P, EXPIRE$$ December 18, 2021
..P`•�'• Bondad Thnr No PWfic UndervrtRero
%4±. „�� aa++i�V�IRE$: December 18, 2021
PubtlaUMennflaro
�,frta�'' Banded Thra NotaryRW
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DATE
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DATE
COMPLETED
Rev.8/2/17