HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FdR APPLICATION TO BEACCEPtED cy�/ /�
Date: 10 I � ' 1 � SCANNED Permit Number: I p to - 0
BY
St. Lucie County
RECEIVED
Building Permit Application OCT 15 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie county, Permitting
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 III
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Lot No.
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION Or WORK:
cpytlezeTe Qcs�o��r�� �„ s 2 [Y,7t/ 81/, 9 Al la AI lie a At rf�,Y l
I, CONSTRUCTION INFORMATION: Ill
IJHVAC U Gas Tank
11Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ . gO/ 170a
Piping ❑_Shutters ❑Windows/Doors
nklers E] Generator E]Roof = Roof pitch
SQ_ _F_t_., of First Floor: _
Utilities: Sewer 1:1 Septic
Building Height:
OWNER/LESSEE:
- '
CONTRACTOR:
Name A"cnp aP /A!/U /
Name: RAk27�_(n?-M'�
AddressN , AW/ /37/1f
Company: C1'Rc)C1'u2e - COIL)
/:'/Z/Z
City: 2T Pt6w&4,;, State: 1':"Z-
Zip Code: 3g9V1 Fax:
Phone No.
Address: e.d. BB?c o96vZ b
City: okleecL10.42-e Stater
Zip Code: ,$y9 7� Fax:
Phone No.' 7J .. 6 _P,/
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: SYR lerel'?C84 461. eaN/
State or County License: GG C O G 103Y
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: 041-
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: aoTo 37 -h-AV
Address:
City: 116 i2o SE.4Cll- State: Fe
Zip: 3 0V7&,n_ Phone '779-569-410ell
City: State:
Zip: Phone:
FEE SIMPLE TITLE OLDER: _ of Applicable
Name: AGDIU r�tt7n V
BONDING COMPANY: _Not Applicable
Name:
Address: D v5 Ao 1 S%3oo ieE o cwrT
Address:
City: OA-vo ,5wea,
City:
Zip:9 /a Phone: 77;3S 69--79(
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 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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA�
STATE OF FLORIDA
COUNTYOF--/Ndrgnl IV
COUNTY OF Si Cace'e
The forgoing instmment was agknowledgefefore me
day of o 20 r l by
thit4#qq
The forgoing instrumeq was acknowledged before me
this fLdayof Cxi 20/dPby
e,L_ LP„eT
A&0,7
Na a on making statement
(Personally Kno OR Produced Identification
Name of person making statement
Personally Known f/ OR Produced Identification
Type o entification
Produced
Typ�Tiientf cation
Produced
@y�y,gupycstateo o e
ignature of Nota Pit otgRS AVKaplan
pMy Commission GG 180278
No. ► d Expire$90tl1�2021
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My Commission GG 24830Commission
Ndp;resoat3nozz (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
CODATE
MPLETED
Rev.8/2/17