HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf — _%
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /1
Date:T� - 'kq SCANNED Permit Number: VCQ
BY
St. Lucie County
vcu i
Building Permit Application
Planning and Development Services OCT 1 8 2018
Building and Code Regulation Division T.
Lucie Count
2300 Virginia Avenue, Fort Pierce FL 34982 y, Permittinr.
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial /� Residential
PERMIT APPLICATION FOR:
To Select from dropbox, click arrow at the end of line
Address:
ufu
Legal Description: LLA-)ri- -1�LC&4ioj (,f- ;+ If f)(LX'.4 o
10{- 8 &r - Aa ( C'r (al- q + 10
Property Tax to#: «ag - Lot N0,9*lo
Site Plan Name: I�p Block No.
Project Name: ' c''^ � OA kD6s ac.1 b ,
Setbacks Front Back: Right Side: Left Side:
�irn off' z").fw 4 Io/
G 2tLn - Lo f Sia_:�a, l A — I a `x IQ' 4
NO e1ec:vY'CG1
vvu,nw uc cnunncu m,uo uup pcn i uL—uieLndu apply:
OHVAC _ Gas Tank Gas Piping _Shutters Windows/Doors
11 Electric Plumbing Sprinklers 1:1 Generator g Roof Roof pitch
Total Sq. Ft of Construction: vv��,,ll ScFt. of First Floor:
Cost of Construction: $ / (e I WV Utilities:Sewer Septic Building Height:
O.W. ,NEB/LE-SSEE:
Name LAA e_Ce)L i
CONTRACTOR:
Name: ban; e_1
Address:Xoo V;vc,inta, -AyG
Company:
_City: F-• Pie�ee_ State: FL -
Zip Code: 34CIBA Fax:
Phone No.
�fi�rr,, �� �
Address:A89 ,�l_iL _ �-tt ,Scn l�
City: a ,af4-
Zip Code: -3499-7
Phone Noo., 1o2I Q63 •
State:-F
Fax: �K a6(Q57
let3a!�
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 1�(YUa+S C �ifl
lnP� Fie XY Ccx1 t
State or County License:
at A(12A
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State: _
City: State:
Zip: Phone
_
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
_
City:
City: —
Zip: Phone:
Zip: Phone: -v
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 Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which isin 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 work or recording your Notice of Commencement.
Signature Contractor as Agent for Owner
Signattfre of Contra or/License Holder
STATE OF FLORIDA
COUNTY `�i A
STATE OF FLORIDA
OF 1 ;
COUNTY OF
The forgging instrument was acknowledged before me
this O I
The for ping instrument was acknowledged�jefore me
ay of 20l by
this ay of by
y
o
Name of perso aking statement
Name of pers eking statement >• U
Personally Known OR Produced Identification
Personally Known OR Produced Identification ¢
_
Type of Identification
Type of Identification Z o.
u.
Produced
Produced i C
¢Z F
,/
( I_
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p
AT
-(Signature of Not
-(Signatu a of NMtary i • -State of Florida )
A K EBNER
Commission No. Notary Ij0l9tF1)• State of Flotlda
•
ion No. Seal)�
, • Commission N GG 047893
4i
My Comm: EXPIFes Nov M 2020
Of i0d
PLANS VEGETATION SEATURTLE MANGROVE
REVIEWS
R N
ZONING —
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
IF
N G
N
W
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
PlannirandvelopmentServicesicesBuildinion
Division
2300 V Pierce FL 34982
PhoneFax:(772)462-1S78 Commercial Resid/tial
PERMITAPPLICATIO FOR: Pline.m �u
To Select from dro box, click arrow at the nd of
PROPOSED IMP�OVEIVI_ �ROGATIONL
A
Legal Description: A 3L •--I:• i-v- t�46ezt LkK-1 a- oeL. QVV� 1�i0.4=a •
Oro I C to -I- q + 6)
Property Tax to#: Igaq - !JUI LotNo.B,�*IJ
Site Plan Name: Block No.
�,' n S`- �
Project Name: 1 (—luasILLL(-io
Setbacks Front Back: Right S e: Left Side:
DEGAIL D DESCRIP ,ION OF WORK
1
@ONSTRU y dON INFfiRMAT10Nc
_Additional work to be nertormed un ert is -perm -c ec _ a app y.
HVAC Gas Tank ❑Ga ❑Windows/Doors
Piping _'Shutte
vElectric OPlumbing prinklers gGenerator Roof Roof pitch
Total Sq. Ft of Construction: s . Ft. of First Floor:
.Co'st of Construction: $ Utilities:OSewer Septic Building Height:
�O NER/,LESSEE:
�„�"���
0
,Name
Nam{�e( ,. 11@1I 1�, C
Address:oivC C) Vie In Ave- •
CS§"7af{i�7
City: �• p�EFc state: f-l•.
tY —
01 41 VUT •• o1111UJ YT.1 -•\
AddrgsY�i�S,. R ,.ate 't�11
Zip Code:.342$' Fax:
y. �y L • �" 'State:F.
Phone No.
Zip Code: (��7�� Fax: ' �505
E-Mail:
Phone No. -7-IJ • a83 • A3R3
Fill in fee simple Title Holder on next page ( if different
E-Mail: f2ra ifs L bcUl i P-I s Ft'e`1PL' . cY11
from the Owner listed above)
State or County License: c;te,`XIIA
If value of construction is SZ500 or more, a RECORDED Notice of Commencement is required.
RUCTION
'SUPPLEMENTAL CONSTLIENy LAW INFORMATION
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
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 contlict 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 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
as Agent SigAature of Contractor/License Holder
STATE OF FLORIDA_ STATE OF FLORIDA — �
COUNTY OF W(jC f A—, I COUNTY OF I'VtftfU 0--)
The forgoin ginstrume t was acknowledgbefore me
this clay of - 201 b
Name of personmaking statement
Personally Known OR Produced Identification
Type of Identification
of Notary
Commission No.
C=m# GG261282
Expires 9/19/2022
REVIEWS I FRONT ZONING
COUNTER REVIEW
COMPLETED
Rev.8/2/17
The5Ing instrcme acknowledged before me
this foday o20 kaby
1 ( e,P I c'-'-Are r e
Name of pe son aking statement
Personally Known OR Produced Identification
Type of Identification
COMM# G028t282
SUPERVISOR
PLANS REVIEW VEGETATION EVIEWI S REVIEW LE MANGROVE
REVIEW