HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o 1 SCANNED Permit Number:
BY
St. Lucie County
Building Permit Application RECEIVED
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
PERMIT APPLICATION FOR: I 0L,
To Select from dropbox, click arrow at therrrd-of-h-
OCT 2 5 2017
�7
PROPOSED IMPROVEMENT LOCATION: Ion � .„1, . _ — i 11
Address: 544f0 Ague. L ,.r. /a A F- Y,•orrn F] 3119t[i- ✓
Legal Description:
Property Tax ID#: ,/0J-q31-00co-6n0 Q -
Site Plan Name: Ha/lam Qa a�t Orn - ocr etn n
Project Name: _p Abor Gra., a t7CQ a.00ry nl :n
Lot No.
Block No.
Setbacks Front Back: Right Side` Left Side: II
DETAILED DESCRIPTION OF WORK:
3 o x 0 Me, \ hcce sso4:� s'x,.rQ. * ryk ce A,I%o_5Q. akft a by hum came
c�:Eo &C &CAO5Z p,_ gII[It
CONSTRUCTION INFORMATION; III
Gas Tank UGas Piping
Li Electric 0 Plumbing []Sprint
Total Sq. Ft of Construction: is 30 �
Cost of Construction: $
Shutters ❑ Windows/Doors
Generator g Roof = Roof pitch
S Ft. of First Floor: _
Utilities: Sewer —Septic
Building Height: Irl _
OWNER/LESSEE:
CONTRACTOR:
Name kl&rkor
` Q2!t-t1 Ore er C
Name: (1f►;d.,&,e J
Address: 6.0o ►J U3 KI,,a 1, {r
Company: Cnrol.,o Gope(j5
City: F••F RVrco State: Q
Zip Code: 3L19LAI o Fax:
Phone No. i')a aA o ;.$3(o
Address: �A65 &k!;LL:±1 `iiww
City: cnke y,-H State: -(-A-
Zip Code: 30t 4-) Fax:Uci-aa43 —05?3X
Phone No. oia9'tiDO • ei0� 4
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: MIKE, M Q, 6AROLVACARMTS. COM
State or County License: UC % a154 8A
-•-� -• ��••�•• ��• v���� mole, a ncwnucu ,vocwe or wmmencement is required.
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 andcovenantsthat 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
commencingwork or recordingour Notice of Commencement.
Rev.8/2/17
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
'
DESIGNER/ENGINEER:
Name: `�2rlch,1 Gn 1ti� en('iti�
Not Applicable
MORTGAGE COMPANY:
Name:
_ of Applicable
Address: (DoS w .tv fFua
Address:
City: '�e4s...d
Zip: Phone �R�
Stater
73K 8tt4U
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_ of Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ L�Ssee/C�as Agent for Owner
Sign of C�oYn�tr or/L Holder
STATE OF fd.$Rf9A Geor��o_
STATE OFf.�DA GLpmJi rt
COUNTY OF LEr
COUNTY OF LEF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of OGIb>rj¢r . 20� by
this � day of Ocln1�C . 20� by
Name of person making statement
Personally Known ✓
Name of person making statement
OR Produc ����
Personally Known ,✓ OR Produced Id�f
Type of Identification P�G••...•�•;,p�i~—
Type of Identification ����E� M�C� •4
Produced
Produced ��.1,PS�Y•.,�.Q��
_rn
(Signature of No ublic-State � •��:
(Signature of Not blic-Stat
Imo,^ �..
•
Commission No. �i*. (5I'.frl"GOJ.'
�� � �a
Commission No. ��� t$Pe{� �,• �
IiyEr�Entee
i ieeO
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV EW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
�O Z
►
%
DATE
�
COMPLETED
/ �P'