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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONND ore Di n..) .Vdh &Oha-j D rus aww& 0imeb ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O U Date: SCANNED P r gmb BY St. Lucie County • Building Permit Appli ation OCT 052018 Planning and Development Services permitting utpartment Building and Code Regulation Division St. Lucie County, EL 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 n.Yw±.. f� .k c,.�•.fWai.l.,,,m ....ASS. ,:. s'" '. �i.....,as+ i- v� 'F:� .e.:3 '. J Address: �D$2D s occ-/tr-�► �i1,d4cr �E,�sc-ter BE�c►< �c 3�p� Legal Description: 14 � -t 77aN bJ 7- ►2EC• A -AC-,/.) �s /� S pZ 06!c Q 06�8 Property Tax ID #: Y Site Plan Name: N0L1-bA1/ ©J&LEA Block No. Project Name: I K ILI 514*b I 62 Lj}C I Setbacks�Front� Back: Z ZO Right Side: Left Side: rD�A+I�LE�© ©E�C,RII �T[IO,N•t�OF UU®R� +: � -``� �"T�" �„�� 'T 2Ej.)ca-C� ►+Ar LJA5 ZrANwC&- Ey��/a�.T_ Il E{DR/Q Jur"iG $i ZG Q AC, C)Nor`5G No Jewi,.HiL, 4a Sc I cwoceo( lo to �,c u GON'ST1R ACTION I.NF'©�RM, AT110N: L _ Additional wor to e e orme under tispermit-checka apply: DHVAC E] Gas Tank ❑Gas Piping _ Shutters Windows/Doors Electric OPlumbing Sprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: / 7" S Ft. of First Floor: Cost of Construction: $ 3 5 0 b Utilities:cnSewer Septic Building Height: OU'VIV�`EtR LESSEE � o i - W�_— Name �/a�L Sr�Eh�+ ljlp o2 O�yGjCda Name:ln4U 19Y0 Address: (C7L9- S 6CC-A-J 22j%1C- Company: City: I E^rSC^J 3(�}C/►f State:FG- Address: O (0S C` 4CV Zip Code: 3V $S7- Fax: 77L 22.1 2-77Z City: C�a State: �� Phone No. 77t--2U-2-5ZG Zip Code:3q�S Fax: E-Mail:_ {te lI de-1b,l+ C beflro0'01 +JG-I— Phone No. `Z7J Fill in fee simple Title Holder on next page (if different E-Mail: _/" e7 C,44 m11 -XJ COL- 4--from the Owner listed above) . State or County License: d+ 3 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 4$ M SUPPLEMENTAL CONSTRUCTION LIEN -LAW INFORMATION: DESIGNER/ENGINEER: Name: IC _ Not Applicable MORTGAGE COMPANY: Name: _ Not Applicable Address: p.o 301c 7,I7 G i 17z Address: City: Zip: Phone State: 9� City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: 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 roams 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 commenciyrKV-5-vk or recording vour Notice of Commencement. Signature STATE OF FLORIDA COUNTY OF �,/G' The ing instrument was acknowledged_ before me fo this day o�(JN� /, 20L by Name of p W makng statement Personally Known OR Produced Identification Type of Identification `(Signature of Nc Commission No. REVIEWS DATE RECEIVED DATE COMPLETED Rev.B/2/17 e or riorEQ@IS R ROCK Notary Public - State of Florida _ COMMASIf17 4 FF 996539 My Comm. Expires Sep 21, 2020 Bonded through National Notary Assn Signature Holder STATE OF FLORIDA I COUNTY OF 5'} • Ltae-t e (2j)LL `F"I The for oing instrument was acknowledged before me this u 2y of 1 20.t-T by EJvrt tc/t Name of person making statement Personally Known OR Produced Identification t/ Type of Ide ification L; S , Produced F /' - (Signature of Notary Public -State of FLorid,3J Notary Public State of Florida -Lis-a8onnr8— My Commission GG 223725 Expires 0513112022 FRONT COUNTER I REVIEW I SUPERVISOR REVIEW I REVIEW VREVIEW ON I SEATURT EV EWLE ZONING MANGROVE REVIEW